Individual
ANASTASIA UDNIKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2020 CENTRE ST, WEST ROXBURY, MA 02132-3316
(617) 325-6700
Mailing address
2020 CENTRE ST, WEST ROXBURY, MA 02132-3316
(617) 325-6700
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
10/15/2014
Last updated
10/15/2014
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