Provider Demographics
NPI:1497836670
Name:YOUNG, EDMUND W (EDD, LCSW, MSG, BCD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:W
Last Name:YOUNG
Suffix:
Gender:M
Credentials:EDD, LCSW, MSG, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GRIFFITH PARK BLVD
Mailing Address - Street 2:#303
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1063
Mailing Address - Country:US
Mailing Address - Phone:323-270-7702
Mailing Address - Fax:323-666-0400
Practice Address - Street 1:11301 WILSHIRE BLVD.
Practice Address - Street 2:BUILDING 257 RM. 212
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW217551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical