Provider Demographics
NPI:1770788390
Name:SUSAN N YOUNG INC
Entity type:Organization
Organization Name:SUSAN N YOUNG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:904-223-6414
Mailing Address - Street 1:13400 SUTTON PARK DR S
Mailing Address - Street 2:SUITE 1504
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0236
Mailing Address - Country:US
Mailing Address - Phone:904-223-6414
Mailing Address - Fax:904-223-6418
Practice Address - Street 1:13400 SUTTON PARK DR S
Practice Address - Street 2:SUITE 1504
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0236
Practice Address - Country:US
Practice Address - Phone:904-223-6414
Practice Address - Fax:904-223-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7306103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF756OtherMEDICARE PTAN