Provider Demographics
NPI:1841578838
Name:YOUNG, KIMBERLY LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:AHEARN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:251 LAFAYETTE ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4067
Mailing Address - Country:US
Mailing Address - Phone:212-570-1693
Mailing Address - Fax:212-431-1731
Practice Address - Street 1:251 LAFAYETTE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4067
Practice Address - Country:US
Practice Address - Phone:212-570-1693
Practice Address - Fax:212-431-1731
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0578121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical