Provider Demographics
NPI:1285461012
Name:MARDIROSSIAN, NAIRI (MFT, PCC)
Entity type:Individual
Prefix:
First Name:NAIRI
Middle Name:
Last Name:MARDIROSSIAN
Suffix:
Gender:F
Credentials:MFT, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 S BALDWIN AVE # 158
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2553
Mailing Address - Country:US
Mailing Address - Phone:949-887-6960
Mailing Address - Fax:
Practice Address - Street 1:1211 CENTER COURT DR STE 106
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3693
Practice Address - Country:US
Practice Address - Phone:626-663-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132892106H00000X
CA11880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional