Healthcare Provider Details

I. General information

NPI: 1548223167
Provider Name (Legal Business Name): ANNASTASIA SAMOILOV CHASE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 COURT ST
ARLINGTON MA
02476-4803
US

IV. Provider business mailing address

7 COURT ST
ARLINGTON MA
02476-4803
US

V. Phone/Fax

Practice location:
  • Phone: 781-483-3366
  • Fax:
Mailing address:
  • Phone: 781-483-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7778
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7778
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: