Provider Demographics
NPI:1508975103
Name:YOUNG, BOZANA N/A (PHD)
Entity Type:Individual
Prefix:DR
First Name:BOZANA
Middle Name:N/A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 UNIVERSITY CITY BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-2708
Mailing Address - Country:US
Mailing Address - Phone:540-961-2380
Mailing Address - Fax:540-961-3408
Practice Address - Street 1:820 UNIVERSITY CITY BLVD # 1
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2708
Practice Address - Country:US
Practice Address - Phone:540-961-2380
Practice Address - Fax:540-961-3408
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS46595Medicare UPIN