Provider Demographics
NPI:1659518785
Name:DAVITYAN, SARINE
Entity Type:Individual
Prefix:
First Name:SARINE
Middle Name:
Last Name:DAVITYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N CENTRAL AVE # 310
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2937
Mailing Address - Country:US
Mailing Address - Phone:818-724-9770
Mailing Address - Fax:818-484-2991
Practice Address - Street 1:1010 N CENTRAL AVE # 310
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202
Practice Address - Country:US
Practice Address - Phone:818-724-9770
Practice Address - Fax:818-484-2991
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT# 52854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7184OtherMEDICAL
CA7368OtherMEDICAL
CA7667OtherMEDICAL
CA7708OtherMEDICAL