Provider Demographics
NPI:1518710664
Name:YAMAMURA, KYOKO (LMSW)
Entity Type:Individual
Prefix:
First Name:KYOKO
Middle Name:
Last Name:YAMAMURA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 SAINT MARKS AVE # 767
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2268
Mailing Address - Country:US
Mailing Address - Phone:917-658-3316
Mailing Address - Fax:
Practice Address - Street 1:367 SAINT MARKS AVE # 767
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2268
Practice Address - Country:US
Practice Address - Phone:917-658-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07096700104100000X
NY123255104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker