Provider Demographics
NPI:1568716470
Name:RADIVOJEVIC, BRANISLAVA LANA (MFTI)
Entity Type:Individual
Prefix:
First Name:BRANISLAVA
Middle Name:LANA
Last Name:RADIVOJEVIC
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3822 HARRISON ST
Mailing Address - Street 2:APT 1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5015
Mailing Address - Country:US
Mailing Address - Phone:619-884-8025
Mailing Address - Fax:
Practice Address - Street 1:3822 HARRISON ST
Practice Address - Street 2:APT 1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5015
Practice Address - Country:US
Practice Address - Phone:619-884-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist