Provider Demographics
NPI:1699417659
Name:YELLIN, BRUCE LEIGH
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:LEIGH
Last Name:YELLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08825-1107
Mailing Address - Country:US
Mailing Address - Phone:908-472-0572
Mailing Address - Fax:
Practice Address - Street 1:10 4TH ST
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08825-1107
Practice Address - Country:US
Practice Address - Phone:908-472-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004338001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical