Provider Demographics
NPI:1669920013
Name:LISTVINSKY, ANDREW (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LISTVINSKY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178309
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92177-8309
Mailing Address - Country:US
Mailing Address - Phone:858-201-6673
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 408
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6939
Practice Address - Country:US
Practice Address - Phone:858-333-6856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1148611041C0700X
CAASW956571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical