Provider Demographics
NPI:1326886649
Name:YAMUCA, VANESSA (LSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:YAMUCA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 AMPERE PKWY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-6539
Mailing Address - Country:US
Mailing Address - Phone:973-461-9253
Mailing Address - Fax:
Practice Address - Street 1:90 PARKER ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1028
Practice Address - Country:US
Practice Address - Phone:973-268-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06361400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker