Provider Demographics
NPI:1437403698
Name:YANAMAYU, DESMOND EUGENE (LISW-S)
Entity Type:Individual
Prefix:MR
First Name:DESMOND
Middle Name:EUGENE
Last Name:YANAMAYU
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:MR
Other - First Name:DESMOND
Other - Middle Name:EUGENE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:4531 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3929
Mailing Address - Country:US
Mailing Address - Phone:330-518-4863
Mailing Address - Fax:
Practice Address - Street 1:13110 SHAKER SQ STE C-200F
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120
Practice Address - Country:US
Practice Address - Phone:330-518-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129424104100000X
OHI.16002801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0247553Medicaid