Provider Demographics
NPI:1164555322
Name:YOUNG, BRENDAN JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:JAMES
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9710
Mailing Address - Country:US
Mailing Address - Phone:267-209-0192
Mailing Address - Fax:267-937-2006
Practice Address - Street 1:595 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9710
Practice Address - Country:US
Practice Address - Phone:267-209-0192
Practice Address - Fax:267-937-2006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0157431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical