Provider Demographics
NPI:1750394631
Name:YENTIN, ALEXANDER (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:YENTIN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 W 28TH ST APT 2348
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2083
Mailing Address - Country:US
Mailing Address - Phone:646-705-8766
Mailing Address - Fax:
Practice Address - Street 1:2980 W 28TH ST APT 2348
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2083
Practice Address - Country:US
Practice Address - Phone:646-705-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076191-11041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical