Provider Demographics
NPI:1831868009
Name:KEOMURJIAN, ANYA VICTORIA
Entity type:Individual
Prefix:MS
First Name:ANYA
Middle Name:VICTORIA
Last Name:KEOMURJIAN
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 1:153 HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-4743
Mailing Address - Country:US
Mailing Address - Phone:617-678-8446
Mailing Address - Fax:
Practice Address - Street 1:8 FANEUIL HALL MARKET PL FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-6114
Practice Address - Country:US
Practice Address - Phone:888-329-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician