Provider Demographics
NPI:1700180353
Name:YESSIN, MARK (CAGS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:YESSIN
Suffix:
Gender:M
Credentials:CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-0343
Mailing Address - Country:US
Mailing Address - Phone:508-428-1407
Mailing Address - Fax:
Practice Address - Street 1:889 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-3067
Practice Address - Country:US
Practice Address - Phone:508-771-2402
Practice Address - Fax:508-762-1291
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst