Provider Demographics
NPI:1598397663
Name:YOUNG, SAM JEFFREY (LCSW)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:JEFFREY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VITA DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-1910
Mailing Address - Country:US
Mailing Address - Phone:516-746-2200
Mailing Address - Fax:516-261-4175
Practice Address - Street 1:17 VITA DR
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-1910
Practice Address - Country:US
Practice Address - Phone:516-746-2200
Practice Address - Fax:516-261-4175
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker