Provider Demographics
NPI:1316651052
Name:CAPELLAN, YENIFER IVELISSE
Entity type:Individual
Prefix:MS
First Name:YENIFER
Middle Name:IVELISSE
Last Name:CAPELLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:IVELISSE
Other - Last Name:CAPELLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:283 MACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2416
Mailing Address - Country:US
Mailing Address - Phone:718-414-9408
Mailing Address - Fax:
Practice Address - Street 1:710 AVENUE S APT C4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3145
Practice Address - Country:US
Practice Address - Phone:718-414-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency