Provider Demographics
NPI:1588106041
Name:VISHNEVSKY, RICHARD GREGORY (LMFT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GREGORY
Last Name:VISHNEVSKY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5287
Mailing Address - Country:US
Mailing Address - Phone:310-571-8156
Mailing Address - Fax:
Practice Address - Street 1:475 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5287
Practice Address - Country:US
Practice Address - Phone:310-571-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96422106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist