Provider Demographics
NPI:1548791189
Name:YOUNG, LUDY (MED,LADC1)
Entity Type:Individual
Prefix:MS
First Name:LUDY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MED,LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3427
Mailing Address - Country:US
Mailing Address - Phone:617-875-5668
Mailing Address - Fax:
Practice Address - Street 1:247 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02121-3427
Practice Address - Country:US
Practice Address - Phone:617-875-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1205101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)