Healthcare Provider Details

I. General information

NPI: 1366951444
Provider Name (Legal Business Name): RITA MARIE RAFI COSTANIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 300
BURBANK CA
91505-4556
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 300
BURBANK CA
91505-4556
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94799
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: