Provider Demographics
NPI:1801188610
Name:KOSARENKO, EKATHERINA (LCSW)
Entity Type:Individual
Prefix:
First Name:EKATHERINA
Middle Name:
Last Name:KOSARENKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATYA
Other - Middle Name:
Other - Last Name:KOSARENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1923 1/2 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8413
Mailing Address - Country:US
Mailing Address - Phone:310-913-3103
Mailing Address - Fax:888-761-0209
Practice Address - Street 1:1923 1/2 WESTWOOD BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8413
Practice Address - Country:US
Practice Address - Phone:310-913-3103
Practice Address - Fax:888-761-0209
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 248701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical