Provider Demographics
NPI:1689127433
Name:YEAMANS, RISA (PSYD)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:YEAMANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:RISA
Other - Middle Name:
Other - Last Name:MANNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:13644 71ST RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1943
Mailing Address - Country:US
Mailing Address - Phone:914-874-4950
Mailing Address - Fax:
Practice Address - Street 1:24302 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:718-423-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NYP12115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist