Provider Demographics
NPI:1467532291
Name:SAMUEL-YOUNG, LESLEY C (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:C
Last Name:SAMUEL-YOUNG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 GLENWOOD RD
Mailing Address - Street 2:#2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1150
Mailing Address - Country:US
Mailing Address - Phone:718-859-0393
Mailing Address - Fax:
Practice Address - Street 1:20-02 SEAGIRT BLVD
Practice Address - Street 2:JBFCS TRANSITION CENTER
Practice Address - City:FAR ROCKAWAY, QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-520-8045
Practice Address - Fax:718-327-4230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055198-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker