Healthcare Provider Details

I. General information

NPI: 1710042700
Provider Name (Legal Business Name): WHITNEY YOUNG HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LARK DR
ALBANY NY
12207-1300
US

IV. Provider business mailing address

1107 BROADWAY
RENSSELAER NY
12144-1919
US

V. Phone/Fax

Practice location:
  • Phone: 518-465-9345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number11365
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11365
License Number StateNY

VIII. Authorized Official

Name: MS. EMILY WATSON
Title or Position: CASAC
Credential:
Phone: 518-465-9345