MEDICARE: DR. ROOZAN VARTERESSIAN PH.D., LCSW

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	103T00000X	Psychologist	PSY19106	CA
2	1041C0700X	Clinical Social Worker	LCS15016	CA

General Provider Information

NPI Number	:	1619109709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROOZAN VARTERESSIAN PH.D., LCSW

Provider Business Mailing Address
First Line	:	16332 AKRON ST
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-2301
Country	:	US
Telephone Number	:	310-625-2506
Fax Number	:

Provider Business Practice Location Address
First Line	:	16332 AKRON ST
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-2301
Country	:	US
Telephone Number	:	310-625-2506
Fax Number	:

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

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	08/21/2009

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