Provider Demographics
NPI:1316665557
Name:YELLEN, MAURA (NCSP)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:YELLEN
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:NORTH FRANKLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06254-1811
Mailing Address - Country:US
Mailing Address - Phone:860-917-5366
Mailing Address - Fax:
Practice Address - Street 1:152 ROUTE 32
Practice Address - Street 2:
Practice Address - City:NORTH FRANKLIN
Practice Address - State:CT
Practice Address - Zip Code:06254-1811
Practice Address - Country:US
Practice Address - Phone:860-917-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool