Individual ProviderKsenia BezugolnayaCounselorBehavioral Health & Social Service ProvidersPractice Address201 Bryson Ave, Staten Island, NY 10314(347) 359-9979PECOS EnrollmentBased on the most recent information from CMS, provider Ksenia Bezugolnaya does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 1:08 PM.Profile DetailsProvider ID1457693897Provider TypeIndividualFull NameBezugolnaya, KseniaGenderFemaleSole ProprietorYesEnumeration Date3/24/2013Last Updated5/21/2018Contact InformationPractice LocationPractice Address201 Bryson Ave, Staten Island, NY 10314Phone(347) 359-9979FaxUnlisted FaxMailing LocationMailing Address201 Bryson Ave, Staten Island, NY 10314-1922Phone(347) 359-9979FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense007324New York