Provider Demographics
NPI:1134280050
Name:YATES, JACQUELINE S (LMSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:S
Last Name:YATES
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2428
Mailing Address - Country:US
Mailing Address - Phone:718-951-9009
Mailing Address - Fax:718-951-9719
Practice Address - Street 1:1463 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2428
Practice Address - Country:US
Practice Address - Phone:718-951-9009
Practice Address - Fax:718-951-9719
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4065101YA0400X
NY074090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)