Provider Demographics
NPI:1700031697
Name:SVETLECIC, NANCY ANNE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:SVETLECIC
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5606
Mailing Address - Country:US
Mailing Address - Phone:310-310-1419
Mailing Address - Fax:
Practice Address - Street 1:1611 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE 305
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5606
Practice Address - Country:US
Practice Address - Phone:310-310-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52434106H00000X
CAIMF 57483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52434OtherLMFT