Provider Demographics
NPI:1952410102
Name:DVOSKINA, YELENA (MA)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:DVOSKINA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 LEXI CIR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9591
Mailing Address - Country:US
Mailing Address - Phone:720-381-7491
Mailing Address - Fax:303-627-6142
Practice Address - Street 1:4450 LEXI CIR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9591
Practice Address - Country:US
Practice Address - Phone:720-381-7491
Practice Address - Fax:303-627-6142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6539101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83006524Medicaid
CO9147539Medicaid