Healthcare Provider Details

I. General information

NPI: 1457844334
Provider Name (Legal Business Name): MS. COURTNEY LYNN YAVORSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 MENTOR AVE
MENTOR OH
44060-6412
US

IV. Provider business mailing address

290 OVERLOOK BROOK DR
CHAGRIN FALLS OH
44023-6710
US

V. Phone/Fax

Practice location:
  • Phone: 440-354-9924
  • Fax:
Mailing address:
  • Phone: 216-905-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: