Provider Demographics
NPI:1063564094
Name:KHANJIAN, STEVEN H (LPC, & LCADC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
Last Name:KHANJIAN
Suffix:
Gender:M
Credentials:LPC, & LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TENAFLY RD UNIT 441
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-7020
Mailing Address - Country:US
Mailing Address - Phone:201-857-5909
Mailing Address - Fax:201-632-6454
Practice Address - Street 1:1172 E RIDGEWOOD AVE STE 4
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3928
Practice Address - Country:US
Practice Address - Phone:201-857-5909
Practice Address - Fax:201-632-6454
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00126800101YA0400X
NJ37PC00197500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00126800OtherL.C.A.D.C.
NJ37PC00197500OtherL.P.C.