Healthcare Provider Details

I. General information

NPI: 1073477667
Provider Name (Legal Business Name): VITA LUCHITSKAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LOS ANGELES ST
NEWTON MA
02458-1082
US

IV. Provider business mailing address

2 LOS ANGELES ST
NEWTON MA
02458-1082
US

V. Phone/Fax

Practice location:
  • Phone: 413-230-9895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14744
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: