Provider Demographics
NPI:1497298848
Name:YAZMER, AMY EILEEN
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:EILEEN
Last Name:YAZMER
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 1:270 JOHN DOWNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITIAN
Mailing Address - State:CT
Mailing Address - Zip Code:06051
Mailing Address - Country:US
Mailing Address - Phone:860-826-1358
Mailing Address - Fax:860-224-6516
Practice Address - Street 1:270 JOHN DOWNEY DRIVE
Practice Address - Street 2:
Practice Address - City:NEW BRITIAN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-826-1358
Practice Address - Fax:860-224-6516
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001147101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)