Provider Demographics
NPI:1215067194
Name:AGAMYAN, RUZANNA (PHD UNLICENSED)
Entity type:Individual
Prefix:MS
First Name:RUZANNA
Middle Name:
Last Name:AGAMYAN
Suffix:
Gender:F
Credentials:PHD UNLICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E ANGELENO AVE UNIT 403
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2956
Mailing Address - Country:US
Mailing Address - Phone:818-415-2058
Mailing Address - Fax:
Practice Address - Street 1:3208 ROSEMEAD BLVD
Practice Address - Street 2:ENKI
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731
Practice Address - Country:US
Practice Address - Phone:626-227-7001
Practice Address - Fax:626-227-7002
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical