Provider Demographics
NPI:1942328620
Name:LYASHENKO, ALEKSANDR
Entity Type:Individual
Prefix:MR
First Name:ALEKSANDR
Middle Name:
Last Name:LYASHENKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 N FREEWAY BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1294
Mailing Address - Country:US
Mailing Address - Phone:916-648-3999
Mailing Address - Fax:916-648-1919
Practice Address - Street 1:4234 N FREEWAY BLVD STE 500
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1294
Practice Address - Country:US
Practice Address - Phone:916-648-3999
Practice Address - Fax:916-648-1919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW30499104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator