Provider Demographics
NPI:1710433289
Name:ABRAAMYAN-CHAIDEZ, LILIT
Entity Type:Individual
Prefix:
First Name:LILIT
Middle Name:
Last Name:ABRAAMYAN-CHAIDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILIT
Other - Middle Name:
Other - Last Name:ABRAAMYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 E OLIVE AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2132
Mailing Address - Country:US
Mailing Address - Phone:818-446-2522
Mailing Address - Fax:
Practice Address - Street 1:500 E OLIVE AVE STE 540
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2132
Practice Address - Country:US
Practice Address - Phone:818-446-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225C00000X
390200000X
CAPSY31671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program