Provider Demographics
NPI:1275175721
Name:JEFFERSON, YOLANDA (CRPA-P)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:CRPA-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4512
Mailing Address - Country:US
Mailing Address - Phone:212-966-9537
Mailing Address - Fax:
Practice Address - Street 1:181 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4512
Practice Address - Country:US
Practice Address - Phone:212-966-9537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3999175T00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist