Provider Demographics
NPI:1720284953
Name:KOSYAN, ROSE (MS, IMF)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:KOSYAN
Suffix:
Gender:F
Credentials:MS, IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 ROBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3358
Mailing Address - Country:US
Mailing Address - Phone:626-442-1400
Mailing Address - Fax:626-442-1144
Practice Address - Street 1:8629 ROBERT AVE
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3358
Practice Address - Country:US
Practice Address - Phone:626-442-1400
Practice Address - Fax:626-442-1144
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist