Provider Demographics
NPI:1609812395
Name:YOUNG, DIANNE A (LCSW; MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW; MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 MAIN ST
Mailing Address - Street 2:C1
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3479
Mailing Address - Country:US
Mailing Address - Phone:727-421-2617
Mailing Address - Fax:727-216-6346
Practice Address - Street 1:935 MAIN ST
Practice Address - Street 2:C1
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3479
Practice Address - Country:US
Practice Address - Phone:727-421-2617
Practice Address - Fax:727-216-6346
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1610101YM0800X
FLSW9340104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82000753Medicaid
KYP54025Medicare UPIN
KY82000753Medicaid