Provider Demographics
NPI:1184255655
Name:QI, YUAN YUAN
Entity type:Individual
Prefix:
First Name:YUAN YUAN
Middle Name:
Last Name:QI
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 1:125 DELANCEY STREETAPT 2106
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5386
Mailing Address - Country:US
Mailing Address - Phone:612-751-9281
Mailing Address - Fax:
Practice Address - Street 1:125 DELANCEY STREETAPT 2106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5386
Practice Address - Country:US
Practice Address - Phone:612-751-9281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty