Provider Demographics
NPI:1225464886
Name:COSME, YESENIA (CADC)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:COSME
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8473 BUMBLE BEE WAY
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-3423
Mailing Address - Country:US
Mailing Address - Phone:570-972-9774
Mailing Address - Fax:
Practice Address - Street 1:8473 BUMBLE BEE WAY
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-3423
Practice Address - Country:US
Practice Address - Phone:570-972-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8253101YA0400X
NY24536101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)