Provider Demographics
NPI:1609294529
Name:COLUMBEL, YERALDIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:YERALDIN
Middle Name:
Last Name:COLUMBEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YERALDIN
Other - Middle Name:
Other - Last Name:GONZALEZ-ROSAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2434
Mailing Address - Country:US
Mailing Address - Phone:917-538-8302
Mailing Address - Fax:
Practice Address - Street 1:727 N BROADWAY STE A2
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2348
Practice Address - Country:US
Practice Address - Phone:917-538-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0797871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300118984Medicare PIN