Provider Demographics
NPI:1730744269
Name:PETROSYAN, SONA
Entity type:Individual
Prefix:MS
First Name:SONA
Middle Name:
Last Name:PETROSYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W BROADWAY STE 315
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1025
Mailing Address - Country:US
Mailing Address - Phone:323-499-7782
Mailing Address - Fax:
Practice Address - Street 1:600 W BROADWAY STE 315
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1025
Practice Address - Country:US
Practice Address - Phone:600-315-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health