Healthcare Provider Details

I. General information

NPI: 1104527605
Provider Name (Legal Business Name): TIN YAN YEUNG LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 61ST ST
BROOKLYN NY
11220-5162
US

IV. Provider business mailing address

1274 5TH AVE APT 204A
NEW YORK NY
10029-3413
US

V. Phone/Fax

Practice location:
  • Phone: 718-362-6311
  • Fax:
Mailing address:
  • Phone: 408-382-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101160
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11577801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: