Provider Demographics
NPI:1497452288
Name:YOUNG, JEFFREY E (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:M
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-0249
Mailing Address - Country:US
Mailing Address - Phone:845-592-8148
Mailing Address - Fax:845-592-8947
Practice Address - Street 1:1 RIVER PL PH P210
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4392
Practice Address - Country:US
Practice Address - Phone:845-592-8148
Practice Address - Fax:845-592-8947
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009075-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist