Provider Demographics
NPI:1962794636
Name:ABRAHAMYAN, LUSINE
Entity type:Individual
Prefix:
First Name:LUSINE
Middle Name:
Last Name:ABRAHAMYAN
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 1:807 1/2 EAST WINDSOR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205
Mailing Address - Country:US
Mailing Address - Phone:323-344-4444
Mailing Address - Fax:
Practice Address - Street 1:807 E WINDSOR RD
Practice Address - Street 2:1/2
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2407
Practice Address - Country:US
Practice Address - Phone:323-344-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190462AP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)