MEDICARE: MR. SAM JEFFREY YOUNG LCSW

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	100760	NY

General Provider Information

NPI Number	:	1598397663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAM JEFFREY YOUNG LCSW

Provider Business Mailing Address
First Line	:	7901 BROADWAY
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1329
Country	:	US
Telephone Number	:	718-334-2585
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 FRANKLIN AVE STE 300
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-1655
Country	:	US
Telephone Number	:	516-746-2200
Fax Number	:	516-261-4175

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

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	03/30/2026

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