Provider Demographics
NPI:1235141136
Name:LAVRETSKY, ELEANOR (MD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:LAVRETSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 N LINDEN DRIVE SUITE 230
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2264
Mailing Address - Country:US
Mailing Address - Phone:310-246-9249
Mailing Address - Fax:310-246-0186
Practice Address - Street 1:462 N LINDEN DRIVE SUITE 230
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2264
Practice Address - Country:US
Practice Address - Phone:310-246-9249
Practice Address - Fax:310-246-0186
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51035A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A510350Medicaid
F34828Medicare UPIN
CAA51035AMedicare PIN