Provider Demographics
NPI:1760732085
Name:YOUNG, SHAMAR J (LMSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHAMAR
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3301
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-0401
Mailing Address - Country:US
Mailing Address - Phone:203-787-8812
Mailing Address - Fax:203-387-7721
Practice Address - Street 1:30 HAZEL TER STE J
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2240
Practice Address - Country:US
Practice Address - Phone:203-787-8812
Practice Address - Fax:203-387-7721
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid