Healthcare Provider Details

I. General information

NPI: 1396263240
Provider Name (Legal Business Name): MELINE MAZMANYAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N GLENDALE AVE STE B #178 #178
GLENDALE CA
91206
US

IV. Provider business mailing address

350 N GLENDALE AVE STE B #178
GLENDALE CA
91206
US

V. Phone/Fax

Practice location:
  • Phone: 818-649-0930
  • Fax:
Mailing address:
  • Phone: 818-649-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: