Provider Demographics
NPI:1811187412
Name:CHOULAKIAN, LARA
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:CHOULAKIAN
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 1:351 S HUDSON AVE RM 206
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3507
Mailing Address - Country:US
Mailing Address - Phone:626-396-3600
Mailing Address - Fax:
Practice Address - Street 1:351 S HUDSON AVE RM 206
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3507
Practice Address - Country:US
Practice Address - Phone:626-396-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW24160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker