Provider Demographics
NPI:1164159034
Name:YAKOVLEVA, MARIA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:YAKOVLEVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:YAKOVLEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1302 BARCLAY LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2235
Mailing Address - Country:US
Mailing Address - Phone:847-220-7767
Mailing Address - Fax:
Practice Address - Street 1:1302 BARCLAY LN
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-2235
Practice Address - Country:US
Practice Address - Phone:847-220-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
WI5151-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent