Basic Information
| Provider Information | |||||||||
| NPI: | 1326462748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGHVINIAN | ||||||||
| FirstName: | REHAN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20151 NORDHOFF ST | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913116215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184073200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7621 CANOGA AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913044912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185986900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2014 | ||||||||
| LastUpdateDate: | 03/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW 63887 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LCSW77562 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.