Provider Demographics
NPI:1184411597
Name:LOVE, YANIQUE
Entity type:Individual
Prefix:
First Name:YANIQUE
Middle Name:
Last Name:LOVE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1675
Mailing Address - Country:US
Mailing Address - Phone:862-215-3499
Mailing Address - Fax:
Practice Address - Street 1:5030 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1675
Practice Address - Country:US
Practice Address - Phone:862-215-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJP134674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist