Provider Demographics
NPI:1376139691
Name:BATES, YVONNE VICTORIA
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:VICTORIA
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32714 RAILROAD STREET
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:NY
Mailing Address - Zip Code:13643
Mailing Address - Country:US
Mailing Address - Phone:915-861-4738
Mailing Address - Fax:
Practice Address - Street 1:595 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1381
Practice Address - Country:US
Practice Address - Phone:315-788-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health