Provider Demographics
NPI:1760676464
Name:RAVINOVICH, SVETLANA GERZON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:GERZON
Last Name:RAVINOVICH
Suffix:
Gender:F
Credentials:PSYD
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Other - First Name:
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Mailing Address - Street 1:16800 DEVONSHIRE ST STE 212
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7409
Mailing Address - Country:US
Mailing Address - Phone:323-459-4968
Mailing Address - Fax:855-380-5459
Practice Address - Street 1:16800 DEVONSHIRE ST STE 212
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7409
Practice Address - Country:US
Practice Address - Phone:323-459-4968
Practice Address - Fax:855-380-5459
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY24318103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent