Provider Demographics
NPI:1730246125
Name:YOUNG, JUDY D (MA)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:D
Last Name:YOUNG
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:PO BOX 139
Mailing Address - Street 2:1311 HEIGHTS RD
Mailing Address - City:GLOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:154 DUCHESS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-0724
Practice Address - Country:US
Practice Address - Phone:802-334-7451
Practice Address - Fax:802-334-7340
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000714103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist