Basic Information
| Provider Information | |||||||||
| NPI: | 1124221296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAMOKOSKI | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 CURRIE HALL PKWY | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306735812 | ||||||||
| FaxNumber: | 3306737162 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 CURRIE HALL PKWY | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306735812 | ||||||||
| FaxNumber: | 3306737162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 04/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist | 103TC1900X | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC2200X | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TM1800X | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 10024 | 05 | OH | MEDICAID | 10034 | 05 | OH | MEDICAID |