Provider Demographics
NPI:1578169504
Name:LIPOVETSKAYA, YELENA (MA, MS, AMFT)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:LIPOVETSKAYA
Suffix:
Gender:F
Credentials:MA, MS, AMFT
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 6762
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-6762
Mailing Address - Country:US
Mailing Address - Phone:805-770-0834
Mailing Address - Fax:
Practice Address - Street 1:148 AERO CAMINO
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-3149
Practice Address - Country:US
Practice Address - Phone:805-770-0834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT97755106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist