Healthcare Provider Details

I. General information

NPI: 1174457055
Provider Name (Legal Business Name): EMMILY HOVHANNISYAN ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 S MARENGO AVE
PASADENA CA
91101-3113
US

IV. Provider business mailing address

910 E WILSON AVE APT 3
GLENDALE CA
91206-4952
US

V. Phone/Fax

Practice location:
  • Phone: 310-824-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: