Provider Demographics
NPI:1922346212
Name:POWER OF CONNECTION
Entity Type:Organization
Organization Name:POWER OF CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDVEDOVSKI-KHANUKAEV
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-669-6059
Mailing Address - Street 1:17 HENSHAW ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2905
Mailing Address - Country:US
Mailing Address - Phone:617-669-6059
Mailing Address - Fax:617-225-7870
Practice Address - Street 1:17 HENSHAW ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2905
Practice Address - Country:US
Practice Address - Phone:617-669-6059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137231041C0700X
MA2185721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty