Provider Demographics
NPI:1215243274
Name:DAGIRMANJIAN, FAEDRA (PHD)
Entity type:Individual
Prefix:
First Name:FAEDRA
Middle Name:
Last Name:DAGIRMANJIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:FAEDRA
Other - Middle Name:
Other - Last Name:BACKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 WILLIAM ST
Mailing Address - Street 2:COUNSELING CENTER, 8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-346-1526
Mailing Address - Fax:
Practice Address - Street 1:156 WILLIAM ST
Practice Address - Street 2:COUNSELING CENTER, 8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:212-346-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program