Healthcare Provider Details

I. General information

NPI: 1821181967
Provider Name (Legal Business Name): NANETTE HELENA YAVEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CALEBS WAY
GREENPORT NY
11944-2148
US

IV. Provider business mailing address

42 CALEBS WAY
GREENPORT NY
11944-2148
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-8828
  • Fax:
Mailing address:
  • Phone: 631-477-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRO46887-I
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: