Provider Demographics
NPI:1083238356
Name:ROGACHEVSKY MARRIAGE AND FAMILY THERAPY
Entity type:Organization
Organization Name:ROGACHEVSKY MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGACHEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-322-1947
Mailing Address - Street 1:335 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2652
Mailing Address - Country:US
Mailing Address - Phone:949-763-3910
Mailing Address - Fax:
Practice Address - Street 1:335 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2652
Practice Address - Country:US
Practice Address - Phone:949-763-3910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty