Provider Demographics
NPI:1083022024
Name:YOUNG, BRENDA ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 SYLVAN SHORES DR
Mailing Address - Street 2:WATERFORD
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3938
Mailing Address - Country:US
Mailing Address - Phone:248-682-5002
Mailing Address - Fax:
Practice Address - Street 1:2715 SYLVAN SHORES DR
Practice Address - Street 2:WATERFORD
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3938
Practice Address - Country:US
Practice Address - Phone:248-682-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010051371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical