MEDICARE: YVONNE TAYLOR-YORK MA, LLP, CAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301008198	MI

General Provider Information

NPI Number	:	1417056375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE TAYLOR-YORK MA, LLP, CAC

Provider Business Mailing Address
First Line	:	28000 DEQUINDRE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-2468
Country	:	US
Telephone Number	:	586-753-0405
Fax Number	:	586-753-0404

Provider Business Practice Location Address
First Line	:	4777 E OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3241
Country	:	US
Telephone Number	:	313-369-5000
Fax Number	:	313-369-5545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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