MEDICARE: KYOKO YAMAMURA LMSW

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	104100000X	Social Worker	LCSW2140494	MA
2	104100000X	Social Worker	44SL07096700	NJ
3	104100000X	Social Worker	123255	NY

General Provider Information

NPI Number	:	1518710664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYOKO YAMAMURA LMSW

Provider Business Mailing Address
First Line	:	367 SAINT MARKS AVE # 767
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2268
Country	:	US
Telephone Number	:	917-658-3316
Fax Number	:

Provider Business Practice Location Address
First Line	:	367 SAINT MARKS AVE # 767
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2268
Country	:	US
Telephone Number	:	917-658-3316
Fax Number	:

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

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	06/17/2025

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