Provider Demographics
NPI:1083456883
Name:YOUNG, JAMES FREDRICK PATRICK JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FREDRICK PATRICK
Last Name:YOUNG
Suffix:JR
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 1:555 N MAIN ST # 1442
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5722
Mailing Address - Country:US
Mailing Address - Phone:917-673-7023
Mailing Address - Fax:
Practice Address - Street 1:180 CLAREMONT AVE APT 46
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4039
Practice Address - Country:US
Practice Address - Phone:917-673-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW036941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical