Provider Demographics
NPI:1881997161
Name:HERAVI-BURGOS, YASNA JASMINE (PSYD)
Entity type:Individual
Prefix:
First Name:YASNA
Middle Name:JASMINE
Last Name:HERAVI-BURGOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3862 LANCASTER CT
Mailing Address - Street 2:APT. #203
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-4110
Mailing Address - Country:US
Mailing Address - Phone:646-627-4075
Mailing Address - Fax:
Practice Address - Street 1:3862 LANCASTER CT
Practice Address - Street 2:APT. #203
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-4110
Practice Address - Country:US
Practice Address - Phone:646-627-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9579103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist