Provider Demographics
NPI:1497052492
Name:GOLAN, MAYA YAAR
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:YAAR
Last Name:GOLAN
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 1:253 DEAN ST
Mailing Address - Street 2:253 DEAN ST
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2202
Mailing Address - Country:US
Mailing Address - Phone:917-655-2278
Mailing Address - Fax:
Practice Address - Street 1:253 DEAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2202
Practice Address - Country:US
Practice Address - Phone:917-655-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0187351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist