Provider Demographics
NPI:1144271545
Name:YOUNG, JANICE N (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:N
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 EAST ELIZABETH AVE
Mailing Address - Street 2:STE 23
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018
Mailing Address - Country:US
Mailing Address - Phone:610-865-4228
Mailing Address - Fax:610-865-1526
Practice Address - Street 1:35 EAST ELIZABETH AVE
Practice Address - Street 2:STE 23
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018
Practice Address - Country:US
Practice Address - Phone:610-865-4228
Practice Address - Fax:610-865-1526
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007457L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03117300OtherBLUE SHIELD
P3179625OtherOXFORD
PA03117300OtherBLUE SHIELD
609887Medicare ID - Type Unspecified