Provider Demographics
NPI:1366462509
Name:VARTANIAN, LISA MARIE (PHD, MFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:VARTANIAN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 WILSHIRE BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3101
Mailing Address - Country:US
Mailing Address - Phone:213-427-3220
Mailing Address - Fax:213-427-3282
Practice Address - Street 1:3807 WILSHIRE BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3101
Practice Address - Country:US
Practice Address - Phone:213-427-3220
Practice Address - Fax:213-427-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27576101YA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist