Provider Demographics
NPI:1922459486
Name:MINES, YOLANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:MINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:HUDSON-MINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3600 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1052
Mailing Address - Country:US
Mailing Address - Phone:718-881-7600
Mailing Address - Fax:718-395-9123
Practice Address - Street 1:3600 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1052
Practice Address - Country:US
Practice Address - Phone:718-881-7600
Practice Address - Fax:718-395-9123
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0739701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical