Provider Demographics
NPI:1841671120
Name:MAZURKEVICH, MILANA (LICSW)
Entity type:Individual
Prefix:
First Name:MILANA
Middle Name:
Last Name:MAZURKEVICH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1321
Mailing Address - Country:US
Mailing Address - Phone:617-686-9237
Mailing Address - Fax:
Practice Address - Street 1:288 WALNUT ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1948
Practice Address - Country:US
Practice Address - Phone:617-552-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1186901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical