Provider Demographics
NPI:1053588053
Name:VARTAZARIAN, ANI ANAHID (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANI
Middle Name:ANAHID
Last Name:VARTAZARIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WESTWOOD PLAZA, JOHN WOODEN CENTER WEST
Mailing Address - Street 2:BOX 951556, UCLA COUNSELING AND PSYCHOLOGICAL SERVICES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1556
Mailing Address - Country:US
Mailing Address - Phone:310-825-0768
Mailing Address - Fax:310-206-7365
Practice Address - Street 1:221 WESTWOOD PLAZA, JOHN WOODEN CENTER WEST
Practice Address - Street 2:BOX 951556, UCLA COUNSELING AND PSYCHOLOGICAL SERVICES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-825-0768
Practice Address - Fax:310-206-7365
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2012-09-10
Deactivation Date:2009-09-08
Deactivation Code:
Reactivation Date:2012-08-17
Provider Licenses
StateLicense IDTaxonomies
CAPSY25115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist