Healthcare Provider Details

I. General information

NPI: 1750952149
Provider Name (Legal Business Name): YAEL MONSELISE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 11/27/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 9 CROSS ST W
HAWTHORNE NY
10532-1320
US

IV. Provider business mailing address

402 SHERMAN AVE
HAWTHORNE NY
10532-1320
US

V. Phone/Fax

Practice location:
  • Phone: 929-223-6656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104646
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: