Healthcare Provider Details

I. General information

NPI: 1710383666
Provider Name (Legal Business Name): AARON YAVELBERG L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10606 QUEENS BLVD
FOREST HILLS NY
11375-4248
US

IV. Provider business mailing address

6545 YELLOWSTONE BLVD APT. 5C
FOREST HILLS NY
11375-2027
US

V. Phone/Fax

Practice location:
  • Phone: 347-480-9722
  • Fax:
Mailing address:
  • Phone: 347-480-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081918
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: