Provider Demographics
NPI:1821555624
Name:LALIKIAN, ANAIT
Entity Type:Individual
Prefix:
First Name:ANAIT
Middle Name:
Last Name:LALIKIAN
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 1:3104 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3636
Mailing Address - Country:US
Mailing Address - Phone:818-262-7404
Mailing Address - Fax:
Practice Address - Street 1:3104 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3636
Practice Address - Country:US
Practice Address - Phone:818-262-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94572540A44328Medicaid