Provider Demographics
NPI:1548223167
Name:CHASE, ANNASTASIA SAMOILOV (PHD)
Entity Type:Individual
Prefix:
First Name:ANNASTASIA
Middle Name:SAMOILOV
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 COURT ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4803
Mailing Address - Country:US
Mailing Address - Phone:781-483-3366
Mailing Address - Fax:
Practice Address - Street 1:7 COURT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4803
Practice Address - Country:US
Practice Address - Phone:781-483-3366
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7778103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA409331OtherTUFTS
Q04410OtherBLUE CROSS
MA016058OtherPBHI
Q04410OtherBLUE CROSS