Provider Demographics
NPI:1891842951
Name:LITVINOV, LARISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARISA
Middle Name:
Last Name:LITVINOV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:LITVINOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3680 WILSHIRE BLVD
Mailing Address - Street 2:SUITE P04 #1188
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2709
Mailing Address - Country:US
Mailing Address - Phone:310-800-1297
Mailing Address - Fax:
Practice Address - Street 1:3680 WILSHIRE BLVD
Practice Address - Street 2:SUITE P04 #1188
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2709
Practice Address - Country:US
Practice Address - Phone:310-800-1297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent