Provider Demographics
NPI:1689823155
Name:YOUNGCLAUS, ELISABETH CORLISS (LCSW, JD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:CORLISS
Last Name:YOUNGCLAUS
Suffix:
Gender:F
Credentials:LCSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 COURT ST
Mailing Address - Street 2:SUITE 1614
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-0103
Mailing Address - Country:US
Mailing Address - Phone:917-400-2241
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 1614
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:917-400-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080293-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical