Provider Demographics
NPI:1366175960
Name:YELLOTT, RYAN (LMSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:YELLOTT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SANDERS RD
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-3401
Mailing Address - Country:US
Mailing Address - Phone:315-261-2977
Mailing Address - Fax:
Practice Address - Street 1:7513 COURT STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932
Practice Address - Country:US
Practice Address - Phone:518-873-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115820104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker