Provider Demographics
NPI:1366501421
Name:KOUMIDOU-VLESMAS, YOLANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:KOUMIDOU-VLESMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PICCADILLY DWNS
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3114
Mailing Address - Country:US
Mailing Address - Phone:516-568-0306
Mailing Address - Fax:516-568-0009
Practice Address - Street 1:150 PICCADILLY DWNS
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3114
Practice Address - Country:US
Practice Address - Phone:516-568-0306
Practice Address - Fax:516-568-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0332651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical