MEDICARE: STEPHANIE YUAN EDM, MA, MHC-LP

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	101YM0800X	Mental Health Counselor	18-P135498-01	NY

General Provider Information

NPI Number	:	1831054394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE YUAN EDM, MA, MHC-LP

Provider Business Mailing Address
First Line	:	1181 BROADWAY FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3024
Country	:	US
Telephone Number	:	347-788-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1181 BROADWAY FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3024
Country	:	US
Telephone Number	:	407-417-3182
Fax Number	:

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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