Provider Demographics
NPI:1437536679
Name:YAGUDAEV, EVELINA
Entity Type:Individual
Prefix:
First Name:EVELINA
Middle Name:
Last Name:YAGUDAEV
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 1:348 13TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6177
Mailing Address - Country:US
Mailing Address - Phone:718-788-2461
Mailing Address - Fax:
Practice Address - Street 1:348 13TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6177
Practice Address - Country:US
Practice Address - Phone:718-788-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP95765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health