Provider Demographics
NPI:1871902213
Name:SHIN, YOUNG-IN (LCSW)
Entity type:Individual
Prefix:
First Name:YOUNG-IN
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 GREEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2724
Mailing Address - Country:US
Mailing Address - Phone:917-494-5749
Mailing Address - Fax:
Practice Address - Street 1:135 MURPHY PL APT 4
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-8820
Practice Address - Country:US
Practice Address - Phone:917-494-5749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082373-1104100000X
NJ44SC059848001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker