Provider Demographics
NPI:1588806293
Name:YEAGER, ROY KENNETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:KENNETH
Last Name:YEAGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1746
Mailing Address - Country:US
Mailing Address - Phone:212-288-8945
Mailing Address - Fax:212-288-5445
Practice Address - Street 1:81 E 77TH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1852
Practice Address - Country:US
Practice Address - Phone:212-288-8945
Practice Address - Fax:212-288-5445
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076402-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical