Provider Demographics
NPI:1477027126
Name:YEO, JINWON (MA)
Entity Type:Individual
Prefix:
First Name:JINWON
Middle Name:
Last Name:YEO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JINWON
Other - Middle Name:
Other - Last Name:HYUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:75 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3522
Mailing Address - Country:US
Mailing Address - Phone:201-541-8600
Mailing Address - Fax:201-541-8100
Practice Address - Street 1:75 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3522
Practice Address - Country:US
Practice Address - Phone:201-541-8600
Practice Address - Fax:201-541-8100
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
NJ37AC00332200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health