Provider Demographics
NPI:1013653674
Name:TOUSSAINT-GOURGUE, YOLENE
Entity Type:Individual
Prefix:
First Name:YOLENE
Middle Name:
Last Name:TOUSSAINT-GOURGUE
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 1:7649 HEWLETT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1429
Mailing Address - Country:US
Mailing Address - Phone:212-388-1903
Mailing Address - Fax:
Practice Address - Street 1:17 BALFOUR ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1524
Practice Address - Country:US
Practice Address - Phone:347-497-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP114586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health