Provider Demographics
NPI:1871097923
Name:YASSON, LAURA ELLA
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ELLA
Last Name:YASSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARINER ST
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2904
Mailing Address - Country:US
Mailing Address - Phone:631-848-7778
Mailing Address - Fax:
Practice Address - Street 1:49 WIRELESS BLVD STE 170
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3946
Practice Address - Country:US
Practice Address - Phone:631-869-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst