Provider Demographics
NPI:1205862224
Name:YOUNG, NANCY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CADILLAC AVE
Mailing Address - Street 2:STE O109
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1448
Mailing Address - Country:US
Mailing Address - Phone:714-732-9856
Mailing Address - Fax:714-432-7075
Practice Address - Street 1:3505 CADILLAC AVE
Practice Address - Street 2:BLDG O, SUITE 109
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1429
Practice Address - Country:US
Practice Address - Phone:714-432-9856
Practice Address - Fax:714-432-7075
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL 119610OtherBLUE SHIELD OF CALIFORNIA
CACP11961AMedicare ID - Type Unspecified