Provider Demographics
NPI:1831904838
Name:SAMVELYAN, DIANA (BCBA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SAMVELYAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 MOUNTAIR AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1216
Mailing Address - Country:US
Mailing Address - Phone:818-744-7223
Mailing Address - Fax:
Practice Address - Street 1:2931 HONOLULU AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3912
Practice Address - Country:US
Practice Address - Phone:818-744-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-25-79087103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst