MEDICARE: LAURA L YOUNG LCSW-R, CGP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	73 076010-R	NY

General Provider Information

NPI Number	:	1093927279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L YOUNG LCSW-R, CGP

Provider Business Mailing Address
First Line	:	130 5TH AVE
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10011-4306
Country	:	US
Telephone Number	:	212-581-9466
Fax Number	:	212-807-0706

Provider Business Practice Location Address
First Line	:	130 5TH AVE
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10011-4306
Country	:	US
Telephone Number	:	212-581-9466
Fax Number	:	212-807-0706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/18/2012

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