Provider Demographics
NPI:1831533744
Name:TANCREDI, YVONNE (LCSW)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:TANCREDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:38 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1722
Mailing Address - Country:US
Mailing Address - Phone:646-348-0113
Mailing Address - Fax:
Practice Address - Street 1:777 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3409
Practice Address - Country:US
Practice Address - Phone:718-875-1420
Practice Address - Fax:718-875-5496
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker