Provider Demographics
NPI:1912129115
Name:YOUNG, MITCHELL LEE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:LEE
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 1:1981 MARCUS AVE
Mailing Address - Street 2:SUITE C119
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1038
Mailing Address - Country:US
Mailing Address - Phone:516-390-3525
Mailing Address - Fax:516-396-2195
Practice Address - Street 1:1981 MARCUS AVE
Practice Address - Street 2:SUITE C119
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1038
Practice Address - Country:US
Practice Address - Phone:516-390-3525
Practice Address - Fax:516-396-2195
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0440341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical