Healthcare Provider Details

I. General information

NPI: 1093450710
Provider Name (Legal Business Name): SHOUSHANNA ZOGRABYAN-ROSTOMYAN ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N JACKSON ST
GLENDALE CA
91206-4380
US

IV. Provider business mailing address

13522 PINNEY ST
PACOIMA CA
91331-2948
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-3111
  • Fax:
Mailing address:
  • Phone: 818-849-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number104197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: