Provider Demographics
NPI:1194412866
Name:BERENJIAN, LAYLA MARIE
Entity type:Individual
Prefix:
First Name:LAYLA
Middle Name:MARIE
Last Name:BERENJIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8060 STATE HIGHWAY 55 STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-9407
Mailing Address - Country:US
Mailing Address - Phone:612-234-2246
Mailing Address - Fax:
Practice Address - Street 1:8060 STATE HIGHWAY 55 STE 100
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-9407
Practice Address - Country:US
Practice Address - Phone:612-234-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)