Provider Demographics
NPI:1740744432
Name:YEHUDAI, NIR (LMSW)
Entity Type:Individual
Prefix:
First Name:NIR
Middle Name:
Last Name:YEHUDAI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 PROSPECT ST APT A2
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2117
Mailing Address - Country:US
Mailing Address - Phone:203-606-0195
Mailing Address - Fax:
Practice Address - Street 1:386 PROSPECT ST APT A2
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2117
Practice Address - Country:US
Practice Address - Phone:203-606-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker