Healthcare Provider Details

I. General information

NPI: 1962318386
Provider Name (Legal Business Name): LILY NAZARIAN MS, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MILFORD ST RM 2106
GLENDALE CA
91203-1708
US

IV. Provider business mailing address

350 W LOMITA AVE APT 204
GLENDALE CA
91204-1659
US

V. Phone/Fax

Practice location:
  • Phone: 818-468-6151
  • Fax:
Mailing address:
  • Phone: 818-468-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: