Provider Demographics
NPI:1316212160
Name:PADILLA, YANCY EVELYN (LSWA)
Entity Type:Individual
Prefix:MS
First Name:YANCY
Middle Name:EVELYN
Last Name:PADILLA
Suffix:
Gender:F
Credentials:LSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 COLD MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6214
Mailing Address - Country:US
Mailing Address - Phone:301-598-5208
Mailing Address - Fax:
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:#220A
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7512
Practice Address - Country:US
Practice Address - Phone:301-431-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17788104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker