Provider Demographics
NPI:1700979440
Name:ACOSTA- MARTINEZ, YVONNE EVANGELISTA (LCSW)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:EVANGELISTA
Last Name:ACOSTA- MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FRANKLIIN AVE.
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114
Mailing Address - Country:US
Mailing Address - Phone:860-292-3082
Mailing Address - Fax:860-293-0828
Practice Address - Street 1:555 FRANKLIIN AVE.
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114
Practice Address - Country:US
Practice Address - Phone:860-292-3082
Practice Address - Fax:860-293-0828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical