MEDICARE: HERMINE KHACHIKYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW80563	CA

General Provider Information

NPI Number	:	1497880496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERMINE KHACHIKYAN

Provider Business Mailing Address
First Line	:	1055 E COLORADO BLVD FL 5
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2327
Country	:	US
Telephone Number	:	626-788-6634
Fax Number	:	626-684-3732

Provider Business Practice Location Address
First Line	:	1055 E COLORADO BLVD FL 5
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2327
Country	:	US
Telephone Number	:	626-788-6634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	11/14/2023

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