Individual
KARINA YAKUBOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6509 99TH ST, APT 3S, REGO PARK, NY 11374-3529
(347) 445-0041
Mailing address
6509 99TH ST APT 3S, REGO PARK, NY 11374-3529
(347) 445-0041
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1417648201
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
742329461-00
FIDELIS CARE
NY
Enumeration date
09/23/2020
Last updated
09/29/2020
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