Provider Demographics
NPI:1427496553
Name:YOUNG, KELLY JEAN
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JEAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:53 LASHER RD
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-9587
Mailing Address - Country:US
Mailing Address - Phone:518-258-6374
Mailing Address - Fax:
Practice Address - Street 1:251 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4617
Practice Address - Country:US
Practice Address - Phone:518-258-6374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730447921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical