Healthcare Provider Details

I. General information

NPI: 1760287635
Provider Name (Legal Business Name): NIKITA SKY YEATTS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2025
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 KINGSLAND AVE APT 4B
BROOKLYN NY
11222-6492
US

IV. Provider business mailing address

166 KINGSLAND AVE APT 4B
BROOKLYN NY
11222-6492
US

V. Phone/Fax

Practice location:
  • Phone: 912-399-8840
  • Fax:
Mailing address:
  • Phone: 912-399-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number126036
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: