Provider Demographics
NPI:1386639730
Name:YOUNG, PATRICIA J (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:HEILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:200 N 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:40 PEARL ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3231
Practice Address - Country:US
Practice Address - Phone:717-397-8081
Practice Address - Fax:717-397-8414
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PAPS016408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103408562Medicaid