Provider Demographics
NPI:1740601939
Name:KESHISHIAN, HERMINEH (MSW)
Entity Type:Individual
Prefix:MRS
First Name:HERMINEH
Middle Name:
Last Name:KESHISHIAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E ANGELENO AVE
Mailing Address - Street 2:#105
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2286
Mailing Address - Country:US
Mailing Address - Phone:818-658-5502
Mailing Address - Fax:818-751-5171
Practice Address - Street 1:421 E ANGELENO AVE
Practice Address - Street 2:#105
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2286
Practice Address - Country:US
Practice Address - Phone:818-658-5502
Practice Address - Fax:818-751-5171
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-15
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical