Healthcare Provider Details

I. General information

NPI: 1750754917
Provider Name (Legal Business Name): ELENA PUSHIN LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15233 VENTURA BLVD STE 1208
SHERMAN OAKS CA
91403-2271
US

IV. Provider business mailing address

15233 VENTURA BLVD STE 1208
SHERMAN OAKS CA
91403-2271
US

V. Phone/Fax

Practice location:
  • Phone: 818-305-4615
  • Fax:
Mailing address:
  • Phone: 818-305-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 26217
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELENA PUSHIN
Title or Position: OWNER
Credential:
Phone: 818-305-4615