Provider Demographics
NPI:1194530014
Name:BAE, KENNETH YOUNG (LSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:YOUNG
Last Name:BAE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5801
Mailing Address - Country:US
Mailing Address - Phone:609-455-4283
Mailing Address - Fax:
Practice Address - Street 1:1 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5801
Practice Address - Country:US
Practice Address - Phone:609-455-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL070398001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical