Organization
MARIYA YAKUTILOVA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIYA YAKUTILOVA (COTA)
(646) 402-4543
Entity
Organization
Contact information
Practice address
10812 72ND AVE, FOREST HILLS, NY 11375-7079
(646) 402-4543
Mailing address
9823 HORACE HARDING EXPY APT 6E, CORONA, NY 11368-4258
(646) 402-4543
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
007061
NY
Other
Enumeration date
04/30/2014
Last updated
04/30/2014
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