Provider Demographics
NPI:1952494411
Name:YAMANAKA, MOMI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOMI
Middle Name:
Last Name:YAMANAKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-1064
Mailing Address - Country:US
Mailing Address - Phone:317-517-8817
Mailing Address - Fax:888-443-4046
Practice Address - Street 1:13295 ILLINOIS ST STE 216
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3021
Practice Address - Country:US
Practice Address - Phone:317-983-1119
Practice Address - Fax:888-443-4046
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-17-28912103K00000X
FL7225103T00000X
PAPS016098103T00000X
IN20042030A103TB0200X, 103TC2200X, 103TF0000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily