Provider Demographics
NPI:1538372339
Name:YOUNGMAN, SUSAN UPTON (MA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:UPTON
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 EPPING RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9008
Mailing Address - Country:US
Mailing Address - Phone:336-766-1487
Mailing Address - Fax:
Practice Address - Street 1:212 EPPING RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9008
Practice Address - Country:US
Practice Address - Phone:336-766-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist