Provider Demographics
NPI:1447638044
Name:LAVENDER, YELENA ZAITSEVA (LCSW74244)
Entity type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:ZAITSEVA
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:LCSW74244
Other - Prefix:MS
Other - First Name:YELENA
Other - Middle Name:ZAITSEVA
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:455 K ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-4107
Mailing Address - Country:US
Mailing Address - Phone:707-464-7224
Mailing Address - Fax:
Practice Address - Street 1:455 K STREET
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531
Practice Address - Country:US
Practice Address - Phone:707-951-4317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CAASW66101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YM0800XMedicaid