Provider Demographics
NPI:1568554541
Name:LESPERANCE, ELENITA BURGOS (MFT)
Entity Type:Individual
Prefix:MS
First Name:ELENITA
Middle Name:BURGOS
Last Name:LESPERANCE
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 1:18546 ROSCOE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4663
Mailing Address - Country:US
Mailing Address - Phone:818-601-0433
Mailing Address - Fax:818-702-8042
Practice Address - Street 1:18546 ROSCOE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4663
Practice Address - Country:US
Practice Address - Phone:818-601-0433
Practice Address - Fax:818-702-8042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist