Provider Demographics
NPI:1013580612
Name:YOUNG, GREGORY EMMANUEL (MHC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:EMMANUEL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 ROUTE 300 # 101
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1738
Mailing Address - Country:US
Mailing Address - Phone:845-567-6027
Mailing Address - Fax:
Practice Address - Street 1:1607 ROUTE 300 # 101
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1738
Practice Address - Country:US
Practice Address - Phone:845-567-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health