| Doctor Name: | DR. YVETTE MARDIS |
| NPI Number: | 1013906767 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D., LCSW |
| License Number: | C005483 |
| Business Practice Address: | 11021 73rd Rd Suite 1j Forest Hills, NY - 113756348 |
| Business Phone Number: | 7186998838 |
| Business Fax Number: | 7186998838 |
| Mailing Address: | 11021 73rd Rd, 1j FOREST HILLS |
| State: | NY |
| Postal Code: | 113756348 |
| Phone Number: | 7186998838 |
| Fax Number: | 7186998838 |
| NPI Enumeration Date: | 10/17/2005 |
| NPI Last Update Date: | 12/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C005483 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |