Provider Demographics
NPI:1366402398
Name:YAMAMOTO, RONALD HIDEYUKI (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:HIDEYUKI
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5311 90TH ST
Mailing Address - Street 2:APT. #2B
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4554
Mailing Address - Country:US
Mailing Address - Phone:718-271-6621
Mailing Address - Fax:718-271-6621
Practice Address - Street 1:2925A KINGS HWY
Practice Address - Street 2:OHEL TIKVAH CLINIC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1805
Practice Address - Country:US
Practice Address - Phone:718-382-0045
Practice Address - Fax:718-859-7157
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072417-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9K141Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER