Provider Demographics
NPI:1558317735
Name:YELLIN, STEVEN A (PHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:YELLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GLEN HEAD RD STE 50
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1945
Mailing Address - Country:US
Mailing Address - Phone:516-674-8403
Mailing Address - Fax:631-543-0791
Practice Address - Street 1:333 GLEN HEAD RD
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1947
Practice Address - Country:US
Practice Address - Phone:516-674-8403
Practice Address - Fax:631-543-0791
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV41993Medicare ID - Type Unspecified