Healthcare Provider Details

I. General information

NPI: 1861573636
Provider Name (Legal Business Name): YVONNE MARIE PRATT LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 WAVERLY AVE
HOLTSVILLE NY
11742-1190
US

IV. Provider business mailing address

2 FRANK ST
EAST PATCHOGUE NY
11772-5908
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-7827
  • Fax: 631-758-7827
Mailing address:
  • Phone: 631-758-7827
  • Fax: 631-758-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR053148-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: