Provider Demographics
NPI:1669164091
Name:YUVEN, TATA
Entity type:Individual
Prefix:
First Name:TATA
Middle Name:
Last Name:YUVEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14808 HAZEN CT
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-2040
Mailing Address - Country:US
Mailing Address - Phone:240-302-0628
Mailing Address - Fax:
Practice Address - Street 1:14808 HAZEN CT
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-2040
Practice Address - Country:US
Practice Address - Phone:240-302-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker