Provider Demographics
NPI:1487848222
Name:HA, YOUNG JU (R-CSW)
Entity Type:Individual
Prefix:
First Name:YOUNG JU
Middle Name:
Last Name:HA
Suffix:
Gender:F
Credentials:R-CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HOWELLS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5320
Mailing Address - Country:US
Mailing Address - Phone:631-647-7885
Mailing Address - Fax:631-647-7893
Practice Address - Street 1:160 HOWELLS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5320
Practice Address - Country:US
Practice Address - Phone:631-647-7885
Practice Address - Fax:631-647-7893
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033027-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical