Provider Demographics
NPI:1689140584
Name:YUVAL, KEREN (MA)
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:YUVAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 GARFIELD PLACE
Mailing Address - Street 2:3L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2110
Mailing Address - Country:US
Mailing Address - Phone:415-860-7804
Mailing Address - Fax:
Practice Address - Street 1:153 GARFIELD PLACE
Practice Address - Street 2:3L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2110
Practice Address - Country:US
Practice Address - Phone:415-860-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
NY002532101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist