Healthcare Provider Details

I. General information

NPI: 1326926353
Provider Name (Legal Business Name): ANASTASIA MEZHERITSKAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ALLSTON ST APT 3
BRIGHTON MA
02135-7629
US

IV. Provider business mailing address

309 ALLSTON ST APT 3
BRIGHTON MA
02135-7629
US

V. Phone/Fax

Practice location:
  • Phone: 408-823-0077
  • Fax:
Mailing address:
  • Phone: 408-823-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW229543
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: