Provider Demographics
NPI:1457473894
Name:TAKEBAYASHI, YOKO (PHD)
Entity Type:Individual
Prefix:DR
First Name:YOKO
Middle Name:
Last Name:TAKEBAYASHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3726
Mailing Address - Country:US
Mailing Address - Phone:646-515-7284
Mailing Address - Fax:
Practice Address - Street 1:125 RIVERSIDE DR
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3726
Practice Address - Country:US
Practice Address - Phone:646-515-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0164961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical