MEDICARE: NADEZDA LEAVITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	133751	CA

General Provider Information

NPI Number	:	1598474033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADEZDA LEAVITT

Provider Business Mailing Address
First Line	:	540 S KENMORE AVE UNIT 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2593
Country	:	US
Telephone Number	:	310-880-5503
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 S KENMORE AVE UNIT 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2593
Country	:	US
Telephone Number	:	310-880-5503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	05/23/2025

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Directions to “ NADEZDA LEAVITT ” Practice Location

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