Provider Demographics
NPI:1104699313
Name:YOUNG, AMANDA J (LMSW, MSED)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMSW, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 13TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2414
Mailing Address - Country:US
Mailing Address - Phone:347-788-8665
Mailing Address - Fax:
Practice Address - Street 1:7706 13TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2414
Practice Address - Country:US
Practice Address - Phone:347-788-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068554-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty