Provider Demographics
NPI:1659996288
Name:LAVAKA, SEINI PEPE
Entity Type:Individual
Prefix:
First Name:SEINI
Middle Name:PEPE
Last Name:LAVAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E 3900 S STE 109
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2568
Mailing Address - Country:US
Mailing Address - Phone:801-604-1286
Mailing Address - Fax:
Practice Address - Street 1:715 E 3900 S STE 109
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2568
Practice Address - Country:US
Practice Address - Phone:801-878-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8980490-35061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical