Provider Demographics
NPI:1912286444
Name:GOZURIAN, LENA (MA)
Entity type:Individual
Prefix:MS
First Name:LENA
Middle Name:
Last Name:GOZURIAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 CHESTNUT ST
Mailing Address - Street 2:APT. #5
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2647
Mailing Address - Country:US
Mailing Address - Phone:415-377-8181
Mailing Address - Fax:
Practice Address - Street 1:1480 LINCOLN AVE STE 8
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2085
Practice Address - Country:US
Practice Address - Phone:415-377-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist