Provider Demographics
NPI:1609088921
Name:YOUNG, DALE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83A BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2647
Mailing Address - Country:US
Mailing Address - Phone:617-522-5293
Mailing Address - Fax:617-522-5293
Practice Address - Street 1:877 BEACON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3801
Practice Address - Country:US
Practice Address - Phone:617-536-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6558103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0523747Medicaid
MAW05232Medicare UPIN
MA0523747Medicaid