Provider Demographics
NPI:1619394277
Name:RAVIV, LINDA (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:RAVIV
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23822 VALENCIA BLVD
Mailing Address - Street 2:SUITE #204
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5302
Mailing Address - Country:US
Mailing Address - Phone:661-505-0168
Mailing Address - Fax:
Practice Address - Street 1:23822 VALENCIA BLVD
Practice Address - Street 2:SUITE #204
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5302
Practice Address - Country:US
Practice Address - Phone:661-505-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS137331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical