Provider Demographics
NPI:1104159789
Name:YANEZ, BETTINA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BETTINA
Middle Name:
Last Name:YANEZ
Suffix:
Gender:F
Credentials:LCSW
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 895123
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34789-5123
Mailing Address - Country:US
Mailing Address - Phone:516-351-1912
Mailing Address - Fax:917-997-8950
Practice Address - Street 1:25 MELVILLE PARK RD STE 53
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3175
Practice Address - Country:US
Practice Address - Phone:631-204-3434
Practice Address - Fax:917-997-8950
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY0812231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03213238Medicaid
NY081223-1OtherLICENSE
NY6849690OtherLICENSE
FLSW19991OtherLICENSE