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General NPI Number Information
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NPI Number | 1104645654
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Entity Type | Individual
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Provider Name | CANDYCE R YOUNG MS,ED,MHC-LP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 4770 SUNRISE HWY STE 102
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-2911
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Country | US
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Telephone | 516-406-8991
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Fax |
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Provider Business Mailing Address
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Address Line | 4770 SUNRISE HWY STE 102
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-2911
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Country | US
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Telephone | 516-406-8991
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Fax | 888-978-6167
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P130570
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License Number State | NY
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