Provider Demographics
NPI:1992261366
Name:YASOVA-ZAFFOS, ARIELA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ARIELA
Middle Name:
Last Name:YASOVA-ZAFFOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 GREEN BAY ROAD
Mailing Address - Street 2:16B (B7, ROOM 224)
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:727-455-0321
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY ROAD
Practice Address - Street 2:16B (B7, ROOM 224)
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:727-455-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3613-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical