Basic Information
| Provider Information | |||||||||
| NPI: | 1841605011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNGE | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | RAQUEL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2090 ADAM CLAYTON POWELL JR BLVD | ||||||||
| Address2: | 4TH FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100274990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125536708 | ||||||||
| FaxNumber: | 2122222318 | ||||||||
| Practice Location | |||||||||
| Address1: | 2090 ADAM CLAYTON POWELL JR BLVD | ||||||||
| Address2: | 4TH FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100274990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125536708 | ||||||||
| FaxNumber: | 2122222318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2014 | ||||||||
| LastUpdateDate: | 10/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.