MEDICARE: MR. LAMONT YOUNG LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	4606	CT

General Provider Information

NPI Number	:	1174292957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAMONT YOUNG LPCA

Provider Business Mailing Address
First Line	:	419 WHALLEY AVENUE
Second Line	:	SUITE 101
City	:	NEW HAVEN
State	:	CT
Zip	:	06511
Country	:	US
Telephone Number	:	203-439-5555
Fax Number	:	203-738-1117

Provider Business Practice Location Address
First Line	:	830 GRAND AVENUE
Second Line	:	SUITE 211
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-0651
Country	:	US
Telephone Number	:	203-439-5555
Fax Number	:	203-738-1117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	09/07/2021

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