MEDICARE: SVETLANA ISHCHENKO LMFT

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	157546	CA

General Provider Information

NPI Number	:	1629784707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA ISHCHENKO LMFT

Provider Business Mailing Address
First Line	:	2995 WOODSIDE RD
Second Line	:
City	:	WOODSIDE
State	:	CA
Zip	:	94062-2443
Country	:	US
Telephone Number	:	858-342-7133
Fax Number	:

Provider Business Practice Location Address
First Line	:	2995 WOODSIDE RD
Second Line	:
City	:	WOODSIDE
State	:	CA
Zip	:	94062-2443
Country	:	US
Telephone Number	:	858-342-7133
Fax Number	:

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

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/09/2026

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