Provider Demographics
NPI:1801212782
Name:YETMAN, DOROTEA NINFA (MS)
Entity Type:Individual
Prefix:MRS
First Name:DOROTEA
Middle Name:NINFA
Last Name:YETMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 FENDALE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3507
Mailing Address - Country:US
Mailing Address - Phone:516-369-1171
Mailing Address - Fax:
Practice Address - Street 1:251 FENDALE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3507
Practice Address - Country:US
Practice Address - Phone:516-369-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst