Provider Demographics
NPI:1316576325
Name:KUZUBOVA, KATERYNA
Entity type:Individual
Prefix:DR
First Name:KATERYNA
Middle Name:
Last Name:KUZUBOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 AJ GORDON CT APT 104
Mailing Address - Street 2:
Mailing Address - City:S HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2347
Mailing Address - Country:US
Mailing Address - Phone:351-444-8735
Mailing Address - Fax:
Practice Address - Street 1:339 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6718
Practice Address - Country:US
Practice Address - Phone:339-368-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA