Provider Demographics
NPI:1689146235
Name:ADAMYAN, ANI
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:ADAMYAN
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 1:6945 KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4042
Mailing Address - Country:US
Mailing Address - Phone:818-856-6620
Mailing Address - Fax:
Practice Address - Street 1:20259 VENTURA BLVD STE 259A
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2551
Practice Address - Country:US
Practice Address - Phone:747-249-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF6900650103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst