Provider Demographics
NPI:1710367164
Name:HARUTUNIAN, MENAS (PSYD)
Entity Type:Individual
Prefix:
First Name:MENAS
Middle Name:
Last Name:HARUTUNIAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 N HOLLYWOOD WAY UNIT 6096
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-8007
Mailing Address - Country:US
Mailing Address - Phone:818-415-4183
Mailing Address - Fax:
Practice Address - Street 1:135 S JACKSON ST STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4918
Practice Address - Country:US
Practice Address - Phone:818-415-4183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31630103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA6758Medicaid
CA7420Medicaid