Healthcare Provider Details

I. General information

NPI: 1285461012
Provider Name (Legal Business Name): NAIRI MARDIROSSIAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 CENTER COURT DR STE 106
COVINA CA
91724-3693
US

IV. Provider business mailing address

61 S BALDWIN AVE # 158
SIERRA MADRE CA
91024-2553
US

V. Phone/Fax

Practice location:
  • Phone: 626-663-1180
  • Fax:
Mailing address:
  • Phone: 949-887-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11880
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: