Provider Demographics
NPI:1417025198
Name:YEVSAEV, ELANA (LMHC)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:YEVSAEV
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAMHA
Mailing Address - Street 2:77B WARREN ST.
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-787-1901
Mailing Address - Fax:617-254-3461
Practice Address - Street 1:BAMHA
Practice Address - Street 2:77B WARREN ST.
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-787-1901
Practice Address - Fax:617-254-3461
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health