Healthcare Provider Details

I. General information

NPI: 1467964692
Provider Name (Legal Business Name): LILIT DAGESIAN MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17203 VENTURA BLVD STE 3
ENCINO CA
91316-4055
US

IV. Provider business mailing address

17203 VENTURA BLVD STE 3
ENCINO CA
91316-4055
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-3615
  • Fax: 818-501-3649
Mailing address:
  • Phone: 818-501-3615
  • Fax: 818-501-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-27433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: