Provider Demographics
NPI:1649403437
Name:PERDOMO, YANET (LCSW)
Entity Type:Individual
Prefix:MS
First Name:YANET
Middle Name:
Last Name:PERDOMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:YANET
Other - Middle Name:
Other - Last Name:PERDOMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 COOPER DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1501
Mailing Address - Country:US
Mailing Address - Phone:845-238-2290
Mailing Address - Fax:
Practice Address - Street 1:2022 JAMES DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6369
Practice Address - Country:US
Practice Address - Phone:646-295-2738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW129701041C0700X, 101YM0800X
NY0717171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical