Provider Demographics
NPI:1962019067
Name:YAKUBOVA, KARINA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:YAKUBOVA
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 1:6509 99TH ST APT 3S
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3529
Mailing Address - Country:US
Mailing Address - Phone:347-445-0041
Mailing Address - Fax:
Practice Address - Street 1:6509 99TH ST
Practice Address - Street 2:APT 3S
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3529
Practice Address - Country:US
Practice Address - Phone:347-445-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1417648201103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY742329461-00OtherFIDELIS CARE