Provider Demographics
NPI:1750924858
Name:LAVAGNINO, LINDA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LAVAGNINO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PINETREE CIR APT 13
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3863
Mailing Address - Country:US
Mailing Address - Phone:310-779-9124
Mailing Address - Fax:
Practice Address - Street 1:17337 VENTURA BLVD STE 218
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3994
Practice Address - Country:US
Practice Address - Phone:310-779-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist