Provider Demographics
NPI:1740870666
Name:YANES, SERGIO OSVALDO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:OSVALDO
Last Name:YANES
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 1:180 BROADWAY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4230
Mailing Address - Country:US
Mailing Address - Phone:516-935-6858
Mailing Address - Fax:
Practice Address - Street 1:180 BROADWAY UNIT 2
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4230
Practice Address - Country:US
Practice Address - Phone:516-935-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)