Healthcare Provider Details

I. General information

NPI: 1538354493
Provider Name (Legal Business Name): MELANYA GRIGORYAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4018 CITY TERRACE DR
LOS ANGELES CA
90063-1242
US

IV. Provider business mailing address

239 N ISABEL ST APT 5
GLENDALE CA
91206-4369
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-3219
  • Fax:
Mailing address:
  • Phone: 818-548-6291
  • 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: