Provider Demographics
NPI:1194171967
Name:YAGHMAIAN, ATASH (LCSW)
Entity type:Individual
Prefix:
First Name:ATASH
Middle Name:
Last Name:YAGHMAIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 LAFAYETTE AVE APT 12E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5688
Mailing Address - Country:US
Mailing Address - Phone:917-334-6635
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE RM 903A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7611
Practice Address - Country:US
Practice Address - Phone:917-334-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0837001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical