Provider Demographics
NPI:1831620483
Name:DAVTYAN, IVETA (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:IVETA
Middle Name:
Last Name:DAVTYAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 1/2 N VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3992
Mailing Address - Country:US
Mailing Address - Phone:310-465-8954
Mailing Address - Fax:
Practice Address - Street 1:7505 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2116
Practice Address - Country:US
Practice Address - Phone:818-353-3772
Practice Address - Fax:818-353-3776
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11624707103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst