Provider Demographics
NPI:1508938754
Name:THEN-YAEGEL, YENI MILAGROS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:YENI
Middle Name:MILAGROS
Last Name:THEN-YAEGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:YENI
Other - Middle Name:MILAGROS
Other - Last Name:THEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, MSW
Mailing Address - Street 1:93 W PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2611
Mailing Address - Country:US
Mailing Address - Phone:201-567-0500
Mailing Address - Fax:201-567-0500
Practice Address - Street 1:93 W PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2611
Practice Address - Country:US
Practice Address - Phone:201-567-0500
Practice Address - Fax:201-567-0500
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055904001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0419460Medicaid