Provider Demographics
NPI:1104645654
Name:YOUNG, CANDYCE R (MS,ED,MHC-LP)
Entity type:Individual
Prefix:MRS
First Name:CANDYCE
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS,ED,MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 SUNRISE HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2911
Mailing Address - Country:US
Mailing Address - Phone:516-406-8991
Mailing Address - Fax:888-978-6167
Practice Address - Street 1:4770 SUNRISE HWY STE 102
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2911
Practice Address - Country:US
Practice Address - Phone:516-406-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health