Healthcare Provider Details

I. General information

NPI: 1104274646
Provider Name (Legal Business Name): YANA GODMACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E 125TH ST
NEW YORK NY
10035-1685
US

IV. Provider business mailing address

2784 E 12TH ST APT 4A
BROOKLYN NY
11235-4604
US

V. Phone/Fax

Practice location:
  • Phone: 718-635-3928
  • Fax:
Mailing address:
  • Phone: 917-655-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW266692
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019352
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096908
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: