Provider Demographics
NPI:1407082092
Name:YOUNG, KARISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7251 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1851
Mailing Address - Country:US
Mailing Address - Phone:414-258-6000
Mailing Address - Fax:414-258-3700
Practice Address - Street 1:7251 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1851
Practice Address - Country:US
Practice Address - Phone:414-258-6000
Practice Address - Fax:414-258-3700
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health