Provider Demographics
NPI:1548534605
Name:DIPLACIDO-EASTMAN, YAEL Y (LCSW)
Entity type:Individual
Prefix:MS
First Name:YAEL
Middle Name:Y
Last Name:DIPLACIDO-EASTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:YAEL
Other - Middle Name:
Other - Last Name:DIPLACIDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:426 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-2811
Mailing Address - Country:US
Mailing Address - Phone:314-660-7473
Mailing Address - Fax:
Practice Address - Street 1:426 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-2811
Practice Address - Country:US
Practice Address - Phone:314-660-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100417071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010041707OtherLICENSE