Provider Demographics
NPI:1225480197
Name:YELIZAROVA, TATYANA (PHD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:YELIZAROVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-5906
Mailing Address - Country:US
Mailing Address - Phone:845-267-2172
Mailing Address - Fax:845-267-2173
Practice Address - Street 1:140 ROUTE 303
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-5906
Practice Address - Country:US
Practice Address - Phone:845-267-2172
Practice Address - Fax:845-267-2173
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker