Provider Demographics
NPI:1023810504
Name:SOLOMON, YIMENUSHAL
Entity type:Individual
Prefix:
First Name:YIMENUSHAL
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 ADAM CLAYTON POWELL JR BLVD APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2550
Mailing Address - Country:US
Mailing Address - Phone:470-753-5620
Mailing Address - Fax:
Practice Address - Street 1:2322 ADAM CLAYTON POWELL JR BLVD APT 3B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2550
Practice Address - Country:US
Practice Address - Phone:470-753-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004142-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty