Provider Demographics
NPI:1689937377
Name:YOUNG, TERISHA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TERISHA
Middle Name:
Last Name: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 1:700 ROSEWOOD ST
Mailing Address - Street 2:APT 5P
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6387
Mailing Address - Country:US
Mailing Address - Phone:917-838-9145
Mailing Address - Fax:
Practice Address - Street 1:521 W 239TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1205
Practice Address - Country:US
Practice Address - Phone:212-581-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080793104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker