1477520492 NPI number — DR. ELIZABETH A YOUNG PSY.D.

Table of content: DR. ELIZABETH A YOUNG PSY.D. (NPI 1477520492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477520492 NPI number — DR. ELIZABETH A YOUNG PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477520492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 WESTFALL RD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-2635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-703-1352
Provider Business Mailing Address Fax Number:
585-241-3730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 WESTFALL RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-703-1352
Provider Business Practice Location Address Fax Number:
585-241-3730
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  015724-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 140080FC . This is a "PREFERRED CARE HEALTH INS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7542585 . This is a "AETNA HEALTH INS." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PO10015724 . This is a "EXCELLUS/BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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