Provider Demographics
NPI:1275799678
Name:LIPKOVICIUS, SVETLANA VEYTS (MFT)
Entity Type:Individual
Prefix:MISS
First Name:SVETLANA
Middle Name:VEYTS
Last Name:LIPKOVICIUS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 815
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-0815
Mailing Address - Country:US
Mailing Address - Phone:858-525-1455
Mailing Address - Fax:
Practice Address - Street 1:7590 FAY AVE
Practice Address - Street 2:#507
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4885
Practice Address - Country:US
Practice Address - Phone:858-525-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist