Healthcare Provider Details

I. General information

NPI: 1083967574
Provider Name (Legal Business Name): MATTHEW YETSKO LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2012
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 JAY ST STE 311
BROOKLYN NY
11201-8360
US

IV. Provider business mailing address

70 WASHINGTON ST APT 3C
BROOKLYN NY
11201-1443
US

V. Phone/Fax

Practice location:
  • Phone: 347-560-8591
  • Fax:
Mailing address:
  • Phone: 347-560-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: