Provider Demographics
NPI:1255543658
Name:YAMMER, MICHAEL DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:YAMMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:YAMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:401 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3024
Mailing Address - Country:US
Mailing Address - Phone:201-833-9399
Mailing Address - Fax:201-833-9398
Practice Address - Street 1:10 MINELL PL
Practice Address - Street 2:SUITE 4
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5508
Practice Address - Country:US
Practice Address - Phone:201-833-9399
Practice Address - Fax:201-833-9398
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00344700103T00000X, 103TB0200X, 103TC2200X, 103TS0200X
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool