Provider Demographics
NPI:1821524125
Name:VARDANYAN, ARMINE
Entity Type:Individual
Prefix:
First Name:ARMINE
Middle Name:
Last Name:VARDANYAN
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 1:14600 SHERMAN WAY
Mailing Address - Street 2:SUITE 100D
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2283
Mailing Address - Country:US
Mailing Address - Phone:818-374-6901
Mailing Address - Fax:
Practice Address - Street 1:12510 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-6732
Practice Address - Country:US
Practice Address - Phone:818-288-5791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT107224106H00000X
CALMFT141556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist