Provider Demographics
NPI:1336689843
Name:YAGLOM PSYCHOTHERAPY L.C.S.W PC
Entity Type:Organization
Organization Name:YAGLOM PSYCHOTHERAPY L.C.S.W PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGLOM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-476-3723
Mailing Address - Street 1:775 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2401
Mailing Address - Country:US
Mailing Address - Phone:917-476-3723
Mailing Address - Fax:
Practice Address - Street 1:775 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2401
Practice Address - Country:US
Practice Address - Phone:917-476-3723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045326-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty