Provider Demographics
NPI:1235809286
Name:VELJANOVSKI, SVITLANA
Entity Type:Individual
Prefix:MS
First Name:SVITLANA
Middle Name:
Last Name:VELJANOVSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 BURBANK BLVD APT 105
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1754
Mailing Address - Country:US
Mailing Address - Phone:323-504-1123
Mailing Address - Fax:
Practice Address - Street 1:1225 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2101
Practice Address - Country:US
Practice Address - Phone:714-972-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT107473106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist