MEDICARE: SERAPHYMA YAKOVLEVA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	089751	NY

General Provider Information

NPI Number	:	1255021671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERAPHYMA YAKOVLEVA LCSW

Provider Business Mailing Address
First Line	:	12007 85TH AVE APT 1E
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3218
Country	:	US
Telephone Number	:	--
Fax Number	:

Provider Business Practice Location Address
First Line	:	12007 85TH AVE APT 1E
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3218
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	05/09/2023

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