Provider Demographics
NPI:1538525340
Name:HAJARIAN, STACY KITTER (LMFT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:KITTER
Last Name:HAJARIAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 6TH ST
Mailing Address - Street 2:UNIT J
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4433
Mailing Address - Country:US
Mailing Address - Phone:310-622-3772
Mailing Address - Fax:
Practice Address - Street 1:1452 26TH ST STE 106
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3042
Practice Address - Country:US
Practice Address - Phone:323-451-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF87165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist