Provider Demographics
NPI:1255543765
Name:DAVIDYAN, RONIT (LCSW, BCD)
Entity type:Individual
Prefix:
First Name:RONIT
Middle Name:
Last Name:DAVIDYAN
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 WILSHIRE BLVD., SUITE 613
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-391-4901
Mailing Address - Fax:310-313-1553
Practice Address - Street 1:10921 WILSHIRE BLVD., SUITE 613
Practice Address - Street 2:
Practice Address - City:LOS ANGELES,
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-391-4901
Practice Address - Fax:310-313-1553
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA179321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical