MEDICARE: SHAMAR J. YOUNG LMSW, 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

General Provider Information

NPI Number	:	1760732085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMAR J. YOUNG LMSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 3301
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06515-0401
Country	:	US
Telephone Number	:	203-787-8812
Fax Number	:	203-387-7721

Provider Business Practice Location Address
First Line	:	30 HAZEL TER STE J
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2240
Country	:	US
Telephone Number	:	203-787-8812
Fax Number	:	203-387-7721

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	05/21/2019

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