MEDICARE: MR. MITCHELL LEE YOUNG L.C.S.W.

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	1041C0700X	Clinical Social Worker	R044034	NY

General Provider Information

NPI Number	:	1912129115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MITCHELL LEE YOUNG L.C.S.W.

Provider Business Mailing Address
First Line	:	1981 MARCUS AVE
Second Line	:	SUITE C119
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1038
Country	:	US
Telephone Number	:	516-390-3525
Fax Number	:	516-396-2195

Provider Business Practice Location Address
First Line	:	1981 MARCUS AVE
Second Line	:	SUITE C119
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1038
Country	:	US
Telephone Number	:	516-390-3525
Fax Number	:	516-396-2195

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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