Provider Demographics
NPI:1356828453
Name:MEYTES, YELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:MEYTES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:SHINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 BENNETT AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2310
Mailing Address - Country:US
Mailing Address - Phone:917-254-5616
Mailing Address - Fax:
Practice Address - Street 1:110 BENNETT AVE APT 4C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2310
Practice Address - Country:US
Practice Address - Phone:917-254-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0844641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty