Healthcare Provider Details

I. General information

NPI: 1124587779
Provider Name (Legal Business Name): KATHERINE MELANIE SARGSYAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 W COLLEGE ST
LOS ANGELES CA
90012-1181
US

IV. Provider business mailing address

7807 AMPERE AVE
NORTH HOLLYWOOD CA
91605-1853
US

V. Phone/Fax

Practice location:
  • Phone: 213-580-7306
  • Fax:
Mailing address:
  • Phone: 818-303-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: