Provider Demographics
NPI:1790409183
Name:UNDERHILL, YAA DUFIE
Entity Type:Individual
Prefix:
First Name:YAA
Middle Name:DUFIE
Last Name:UNDERHILL
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 1:4 PETUNIA DR APT 1F
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3610
Mailing Address - Country:US
Mailing Address - Phone:404-907-7338
Mailing Address - Fax:
Practice Address - Street 1:6 CORNWALL CT STE F
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3347
Practice Address - Country:US
Practice Address - Phone:732-453-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00646100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health