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Organization
POWER OF CONNECTION
Active
Organization
POWER OF CONNECTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELENA MEDVEDOVSKI-KHANUKAEV L.I.C.S.W. (OWNER/CLINICAL SOCIAL WORKER)
(617) 669-6059
Entity
Organization
Contact information
Practice address
17 HENSHAW ST, BRIGHTON, MA 02135-2905
(617) 669-6059
Mailing address
17 HENSHAW ST, BRIGHTON, MA 02135-2905
(617) 669-6059
(617) 225-7870
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
113723
MA
1041C0700X
Clinical Social Worker
218572
MA
Other
Enumeration date
01/22/2013
Last updated
08/30/2013
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