Provider Demographics
NPI:1558873091
Name:YANNARELLI, AMANDA L (CASAC-T)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:YANNARELLI
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PUGSLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1007
Mailing Address - Country:US
Mailing Address - Phone:914-729-4940
Mailing Address - Fax:914-737-2508
Practice Address - Street 1:3 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-1846
Practice Address - Country:US
Practice Address - Phone:914-257-3500
Practice Address - Fax:914-737-2508
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33713101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1487709671Medicaid