Basic Information
| Provider Information | |||||||||
| NPI: | 1023058492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAKAMOVICH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MA, LLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | YAKAMOVICH | ||||||||
| OtherFirstName: | DREW | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MA, LLP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 28000 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480922468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867530405 | ||||||||
| FaxNumber: | 5867530404 | ||||||||
| Practice Location | |||||||||
| Address1: | 1026 E 11 MILE RD | ||||||||
| Address2: | #100 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480671970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485464772 | ||||||||
| FaxNumber: | 2483990083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301010820 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.