Provider Demographics
NPI:1376707554
Name:BURGINA, LYUBOV (LMFT, PSYD)
Entity type:Individual
Prefix:MRS
First Name:LYUBOV
Middle Name:
Last Name:BURGINA
Suffix:
Gender:F
Credentials:LMFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14903 S NORMANDIE AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2968
Mailing Address - Country:US
Mailing Address - Phone:323-606-3200
Mailing Address - Fax:323-849-3396
Practice Address - Street 1:14903 S NORMANDIE AVE APT 214
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-2968
Practice Address - Country:US
Practice Address - Phone:323-606-3200
Practice Address - Fax:323-849-3396
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist