Provider Demographics
NPI:1396179818
Name:YOUNG, JOHN WILLIAM JR (PSYD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIAM
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ADMINISTRATION ROAD
Mailing Address - Street 2:BRIDGEWATER STATE HOSPITAL- FORENSIC SERVICES
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02034
Mailing Address - Country:US
Mailing Address - Phone:508-279-4500
Mailing Address - Fax:
Practice Address - Street 1:20 ADMINISTRATION ROAD
Practice Address - Street 2:BRIDGEWATER STATE HOSPITAL- FORENSIC SERVICES
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02034
Practice Address - Country:US
Practice Address - Phone:508-279-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10402103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic