Provider Demographics
NPI:1780160127
Name:VESCOVO, CHRISTINA W (MFT ASSOCIATE)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:W
Last Name:VESCOVO
Suffix:
Gender:F
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 VISTA PACIFICA UNIT 10
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4832
Mailing Address - Country:US
Mailing Address - Phone:131-474-3711
Mailing Address - Fax:
Practice Address - Street 1:22809 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5873
Practice Address - Country:US
Practice Address - Phone:424-346-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist