Provider Demographics
NPI:1215039656
Name:YOUNG, SUSAN NILETTE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:NILETTE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 IRONWOOD DR
Mailing Address - Street 2:UNIT 635
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5219
Mailing Address - Country:US
Mailing Address - Phone:904-477-3124
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7306103G00000X
FLPY 7306103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical