Provider Demographics
NPI:1902913536
Name:YOUNG, BEVERLY SUSAN (CAS)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:SUSAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 FINSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3817
Mailing Address - Country:US
Mailing Address - Phone:916-334-3003
Mailing Address - Fax:
Practice Address - Street 1:2801 ARAMON DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4803
Practice Address - Country:US
Practice Address - Phone:916-429-7977
Practice Address - Fax:916-429-7943
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-068573101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)