Provider Demographics
NPI:1609464494
Name:RAVELO, YENISEL (LMSW)
Entity Type:Individual
Prefix:
First Name:YENISEL
Middle Name:
Last Name:RAVELO
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 1:14220 84TH DR APT 7F
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2103
Mailing Address - Country:US
Mailing Address - Phone:646-508-7042
Mailing Address - Fax:
Practice Address - Street 1:153 W 27TH ST STE 300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6259
Practice Address - Country:US
Practice Address - Phone:917-283-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111085-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker