Provider Demographics
NPI:1871161992
Name:YONICK, BROOKE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:YONICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1704
Mailing Address - Country:US
Mailing Address - Phone:631-472-7860
Mailing Address - Fax:
Practice Address - Street 1:189 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1704
Practice Address - Country:US
Practice Address - Phone:631-472-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker