MEDICARE: MS. DEBRA ROBIN YATES LCSW

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	LCS20839	CA

General Provider Information

NPI Number	:	1770791097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA ROBIN YATES LCSW

Provider Business Mailing Address
First Line	:	500 DAVIS ST STE 120
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-2759
Country	:	US
Telephone Number	:	510-481-4203
Fax Number	:	510-481-4269

Provider Business Practice Location Address
First Line	:	500 DAVIS ST STE 120
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-2759
Country	:	US
Telephone Number	:	510-481-4203
Fax Number	:	510-481-4269

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	04/08/2021

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