Healthcare Provider Details

I. General information

NPI: 1477790830
Provider Name (Legal Business Name): JIYEON HELEN YOO PH.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18A ELMWOOD PARK DR # A3
STATEN ISLAND NY
10314-7501
US

IV. Provider business mailing address

248 E 49TH ST
NEW YORK NY
10017-1548
US

V. Phone/Fax

Practice location:
  • Phone: 646-780-9227
  • Fax:
Mailing address:
  • Phone: 646-780-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number019959-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-06-2772
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number019959-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019959-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number019959-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: