Provider Demographics
NPI:1619109709
Name:VARTERESSIAN, ROOZAN (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ROOZAN
Middle Name:
Last Name:VARTERESSIAN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16332 AKRON ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2301
Mailing Address - Country:US
Mailing Address - Phone:310-625-2506
Mailing Address - Fax:
Practice Address - Street 1:16332 AKRON ST
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2301
Practice Address - Country:US
Practice Address - Phone:310-625-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19106103T00000X
CALCS150161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical