Provider Demographics
NPI:1548469711
Name:STUART YOUNG, PH.D. ASSOCIATES P.A.
Entity type:Organization
Organization Name:STUART YOUNG, PH.D. ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-241-0666
Mailing Address - Street 1:302 3RD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-5131
Mailing Address - Country:US
Mailing Address - Phone:904-241-0666
Mailing Address - Fax:904-241-0289
Practice Address - Street 1:302 3RD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5131
Practice Address - Country:US
Practice Address - Phone:904-241-0666
Practice Address - Fax:904-241-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2703103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3634Medicare PIN