Provider Demographics
NPI:1750754917
Name:ELENA PUSHIN LCSW
Entity type:Organization
Organization Name:ELENA PUSHIN LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-305-4615
Mailing Address - Street 1:15233 VENTURA BLVD STE 1208
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2271
Mailing Address - Country:US
Mailing Address - Phone:818-305-4615
Mailing Address - Fax:
Practice Address - Street 1:15233 VENTURA BLVD STE 1208
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2271
Practice Address - Country:US
Practice Address - Phone:818-305-4615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CALCS 262171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty