Provider Demographics
NPI:1619405131
Name:YU, YUANYUAN (MSW)
Entity Type:Individual
Prefix:
First Name:YUANYUAN
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6787 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-352-8001
Practice Address - Street 1:6787 MARKET ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1848
Practice Address - Country:US
Practice Address - Phone:215-593-7768
Practice Address - Fax:610-352-8001
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134526104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103328971Medicaid