Provider Demographics
NPI:1275756538
Name:LYASHENKO, ANNA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:LYASHENKO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N MARKET BLVD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834
Mailing Address - Country:US
Mailing Address - Phone:916-567-4222
Mailing Address - Fax:916-567-4220
Practice Address - Street 1:601 N MARKET BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834
Practice Address - Country:US
Practice Address - Phone:916-567-4222
Practice Address - Fax:916-567-4220
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAASW28081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator