Provider Demographics
NPI:1447590682
Name:SVETCHNIKOV, ANNA (LMFT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SVETCHNIKOV
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 SW PARADISE CV
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2011
Mailing Address - Country:US
Mailing Address - Phone:789-972-1000
Mailing Address - Fax:617-812-6405
Practice Address - Street 1:26 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907
Practice Address - Country:US
Practice Address - Phone:978-972-1000
Practice Address - Fax:617-812-6405
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4752106H00000X
MA1668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty