Provider Demographics
NPI:1356849921
Name:NEGATU, YONATA
Entity Type:Individual
Prefix:
First Name:YONATA
Middle Name:
Last Name:NEGATU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 BLUE KNOB TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6200
Mailing Address - Country:US
Mailing Address - Phone:240-839-0172
Mailing Address - Fax:
Practice Address - Street 1:2119 BLUE KNOB TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-6200
Practice Address - Country:US
Practice Address - Phone:240-839-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBACB414207106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician