MEDICARE: NIXALY YAKUBOV

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1417615675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIXALY YAKUBOV

Provider Business Mailing Address
First Line	:	45 ECKERT ST
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-3842
Country	:	US
Telephone Number	:	347-450-5542
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 ECKERT ST
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-3842
Country	:	US
Telephone Number	:	347-450-5542
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. NIXALY YAKUBOV
Credential	:	LCSW
Telephone Number	:	347-450-5542

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	05/18/2026

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