Provider Demographics
NPI:1235624909
Name:YACOVELLA, MARIAN K V (MSW, SWC)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:K V
Last Name:YACOVELLA
Suffix:
Gender:F
Credentials:MSW, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 15TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2764
Mailing Address - Country:US
Mailing Address - Phone:330-725-9195
Mailing Address - Fax:
Practice Address - Street 1:630 15TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2764
Practice Address - Country:US
Practice Address - Phone:970-775-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty