Provider Demographics
NPI:1821501479
Name:GRANOVSKY, DIMITRY KLIM (MFTI)
Entity Type:Individual
Prefix:MR
First Name:DIMITRY
Middle Name:KLIM
Last Name:GRANOVSKY
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 S WINDSOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3160
Mailing Address - Country:US
Mailing Address - Phone:213-399-7823
Mailing Address - Fax:
Practice Address - Street 1:321 N LARCHMONT BLVD STE 506
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6405
Practice Address - Country:US
Practice Address - Phone:213-399-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist