Healthcare Provider Details

I. General information

NPI: 1477015451
Provider Name (Legal Business Name): MICHELLE ROSE YANNIELLO LICSW, LCSW, CCFC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 G ST NW STE 800
WASHINGTON DC
20005-6705
US

IV. Provider business mailing address

1109 M ST NW APT 8
WASHINGTON DC
20005-4371
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 631-921-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012900
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50082737
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29192
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: