Provider Demographics
NPI:1801955281
Name:YAGED, PAULETTE S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:S
Last Name:YAGED
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 1:1467 EAST 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6503
Mailing Address - Country:US
Mailing Address - Phone:718-998-1235
Mailing Address - Fax:718-375-0529
Practice Address - Street 1:1467 EAST 10TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6503
Practice Address - Country:US
Practice Address - Phone:718-998-1235
Practice Address - Fax:718-375-0529
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02565311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP788704OtherOXFORD BEH HEALTH
010257801OtherAMERICHOICE
010257801OtherAMERICHOICE