Provider Demographics
NPI:1639597743
Name:AZARIAN, GOHARIK (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:GOHARIK
Middle Name:
Last Name:AZARIAN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TELEMEDICINE SERVICES
Mailing Address - Street 2:16 RUSSELL HILL ROAD
Mailing Address - City:BROOKLINE
Mailing Address - State:NH
Mailing Address - Zip Code:03033
Mailing Address - Country:US
Mailing Address - Phone:323-573-3349
Mailing Address - Fax:
Practice Address - Street 1:16 RUSSELL HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:NH
Practice Address - Zip Code:03033-2103
Practice Address - Country:US
Practice Address - Phone:323-573-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30696OtherCALIFORNIA-SPEECH LANGUAGE PATHOLOGY-AUDIOLOGY
MA9004OtherMASSACHUSETTS SPEECH LANGUAGE PATHOLOGY-AUDIOLOGY BOARD
NY028103OtherNEW YORK SPEECH-LANGUAGE PATHOLOGY-AUDIOLOGY
MA14094086OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION