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General NPI Number Information
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NPI Number | 1093948515
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Entity Type | Individual
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Provider Name | SANDRA LEE COLLINS YOUNG PSY.D., L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 20 YORK STREET
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City | NEW HAVEN
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State | CT
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Zip | 06510-3202
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Country | US
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Telephone | 203-688-9930
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Fax |
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Provider Business Mailing Address
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Address Line | 126 OAK ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-3219
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Country | US
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Telephone | 860-426-9306
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 003927
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License Number State | CT
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