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NPI Code Detail

MEDICARE: SHUSHANIK SUSIE BALASANYAN MA, BCBA

MEDICARE: SHUSHANIK SUSIE BALASANYAN MA, BCBA
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
1103K00000XBehavior Analyst1-11-8337

General Provider Information

NPI Number : 1700151008
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHUSHANIK SUSIE BALASANYAN MA, BCBA
Provider Business Mailing Address
First Line : 19019 VENTURA BLVD
Second Line :
City : TARZANA
State : CA
Zip : 91356-3253
Country : US
Telephone Number : 818-345-2345
Fax Number : 866-587-2383
Provider Business Practice Location Address
First Line : 19019 VENTURA BLVD
Second Line :
City : TARZANA
State : CA
Zip : 91356-3253
Country : US
Telephone Number : 818-345-2345
Fax Number : 866-587-2383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2012
Last Update Date : 03/20/2012

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