Provider Demographics
NPI:1447819081
Name:BETTINA YANEZ LCSW PLLC
Entity type:Organization
Organization Name:BETTINA YANEZ LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-351-1912
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-0852
Mailing Address - Country:US
Mailing Address - Phone:516-351-1912
Mailing Address - Fax:
Practice Address - Street 1:25 MEVILLE PARK RD SUITE 223
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1174
Practice Address - Country:US
Practice Address - Phone:516-351-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY081223OtherINDIVIDUAL