Provider Demographics
NPI:1144577446
Name:FLORES-PINOS, YESENIA GUADALUPE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YESENIA
Middle Name:GUADALUPE
Last Name:FLORES-PINOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 FARNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1204
Mailing Address - Country:US
Mailing Address - Phone:973-432-7230
Mailing Address - Fax:
Practice Address - Street 1:757 TEANECK RD STE A
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4241
Practice Address - Country:US
Practice Address - Phone:973-432-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00492800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0672165Medicaid
NJ0672157Medicaid