MEDICARE: MRS. ROUZANNA AVAGIAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1041C0700X	Clinical Social Worker	123109	CA

General Provider Information

NPI Number	:	1811361272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROUZANNA AVAGIAN LCSW

Provider Business Mailing Address
First Line	:	5748 CEDROS AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411
Country	:	US
Telephone Number	:	818-399-6460
Fax Number	:

Provider Business Practice Location Address
First Line	:	5748 CEDROS AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-3343
Country	:	US
Telephone Number	:	818-399-6460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	12/19/2024

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