Provider Demographics
NPI:1598597171
Name:TADAYON, YASAMEAN
Entity type:Individual
Prefix:
First Name:YASAMEAN
Middle Name:
Last Name:TADAYON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 PINNACLE CT APT 104
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-9526
Mailing Address - Country:US
Mailing Address - Phone:937-478-4828
Mailing Address - Fax:
Practice Address - Street 1:220 S BREIEL BLVD STE C
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5106
Practice Address - Country:US
Practice Address - Phone:513-433-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.24112991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty