Provider Demographics
NPI:1730655424
Name:YETISKUL, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:YETISKUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 PATRICK PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15129-9200
Mailing Address - Country:US
Mailing Address - Phone:412-638-2144
Mailing Address - Fax:
Practice Address - Street 1:1729 PATRICK PL
Practice Address - Street 2:
Practice Address - City:SOUTH PARK
Practice Address - State:PA
Practice Address - Zip Code:15129-9200
Practice Address - Country:US
Practice Address - Phone:412-638-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135436104100000X
PACW0217891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker