Provider Demographics
NPI:1861057135
Name:YOON, YESEL (PHD)
Entity type:Individual
Prefix:DR
First Name:YESEL
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 51ST ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3164
Mailing Address - Country:US
Mailing Address - Phone:301-461-4524
Mailing Address - Fax:
Practice Address - Street 1:3945 51ST ST APT 3F
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3164
Practice Address - Country:US
Practice Address - Phone:301-461-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical