Provider Demographics
NPI:1063018067
Name:MESA, CHRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 OLD COLONY AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2413
Mailing Address - Country:US
Mailing Address - Phone:617-268-5000
Mailing Address - Fax:617-268-5008
Practice Address - Street 1:210 OLD COLONY AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2413
Practice Address - Country:US
Practice Address - Phone:617-268-5000
Practice Address - Fax:617-268-5008
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0002262561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical