Healthcare Provider Details

I. General information

NPI: 1417025198
Provider Name (Legal Business Name): ELANA YEVSAEV LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAMHA 77B WARREN ST.
BRIGHTON MA
02135-3601
US

IV. Provider business mailing address

BAMHA 77B WARREN ST.
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 617-787-1901
  • Fax: 617-254-3461
Mailing address:
  • Phone: 617-787-1901
  • Fax: 617-254-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5995
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: