Provider Demographics
NPI:1205104221
Name:TACTUK, YANETTE LETICIA (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:YANETTE
Middle Name:LETICIA
Last Name:TACTUK
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 89TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1446
Mailing Address - Country:US
Mailing Address - Phone:646-226-6979
Mailing Address - Fax:
Practice Address - Street 1:3119 89TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1446
Practice Address - Country:US
Practice Address - Phone:646-226-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
NY082509-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical