Provider Demographics
NPI:1962706952
Name:GASAMANYAN, MARINE MICHELLE
Entity type:Individual
Prefix:
First Name:MARINE
Middle Name:MICHELLE
Last Name:GASAMANYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 GARFIELD PL APT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5954
Mailing Address - Country:US
Mailing Address - Phone:323-459-0884
Mailing Address - Fax:
Practice Address - Street 1:1832 GARFIELD PL APT 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5954
Practice Address - Country:US
Practice Address - Phone:323-459-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist