Provider Demographics
NPI:1295077949
Name:STEVEN YELLIN CLINICAL PSYCHOLOGIST PC
Entity type:Organization
Organization Name:STEVEN YELLIN CLINICAL PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:YELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-935-4340
Mailing Address - Street 1:333 GLEN HEAD RD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1947
Mailing Address - Country:US
Mailing Address - Phone:631-935-4340
Mailing Address - Fax:631-543-0719
Practice Address - Street 1:333 GLEN HEAD RD
Practice Address - Street 2:SUITE 50
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1947
Practice Address - Country:US
Practice Address - Phone:516-674-8403
Practice Address - Fax:631-543-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09453103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV41993Medicare UPIN