Provider Demographics
NPI:1073520235
Name:YOUNG, ROBERT ELLIOTT (MSW, LMSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ELLIOTT
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PRINCESS DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1714
Mailing Address - Country:US
Mailing Address - Phone:716-834-4270
Mailing Address - Fax:716-862-8886
Practice Address - Street 1:VAWNYHS
Practice Address - Street 2:3495 BAILEY AVENUE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-834-4270
Practice Address - Fax:716-862-8886
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031293104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker