Healthcare Provider Details

I. General information

NPI: 1699123430
Provider Name (Legal Business Name): MOSHE YACHNES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CAMINO REAL
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

3531 NW 4TH AVENUE
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 786-877-1461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13901
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: