Provider Demographics
NPI:1972664050
Name:YATZUS, OLGA ALEXANDRA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:ALEXANDRA
Last Name:YATZUS
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 1:5700 KIRKWOOD HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4857
Mailing Address - Country:US
Mailing Address - Phone:302-273-1634
Mailing Address - Fax:302-407-6988
Practice Address - Street 1:5700 KIRKWOOD HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4857
Practice Address - Country:US
Practice Address - Phone:302-273-1634
Practice Address - Fax:302-407-6988
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health