Provider Demographics
NPI:1164994265
Name:YOUNGER, LEAH REBECCA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:REBECCA
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1666
Mailing Address - Country:US
Mailing Address - Phone:516-515-0898
Mailing Address - Fax:516-307-0898
Practice Address - Street 1:1325 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1666
Practice Address - Country:US
Practice Address - Phone:516-515-0898
Practice Address - Fax:516-307-0898
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21410103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist