Healthcare Provider Details

I. General information

NPI: 1588577084
Provider Name (Legal Business Name): KENDALL ELIZABETH YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HAWKINS AVE
RONKONKOMA NY
11779-2375
US

IV. Provider business mailing address

85 WOODVIEW LN
CENTEREACH NY
11720-4073
US

V. Phone/Fax

Practice location:
  • Phone: 631-240-3579
  • Fax:
Mailing address:
  • Phone: 631-480-4904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2097423261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: