Provider Demographics
NPI:1902624596
Name:BAE, YEONG J (MDIV, MSW)
Entity type:Individual
Prefix:
First Name:YEONG
Middle Name:J
Last Name:BAE
Suffix:
Gender:M
Credentials:MDIV, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 BALLANTINE LN
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2738
Mailing Address - Country:US
Mailing Address - Phone:610-937-5615
Mailing Address - Fax:
Practice Address - Street 1:2003 BALLANTINE LN
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2738
Practice Address - Country:US
Practice Address - Phone:610-937-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker