Provider Demographics
NPI:1639678634
Name:YOUNG, JESSICA R (LPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HUNTINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2612
Mailing Address - Country:US
Mailing Address - Phone:203-205-2628
Mailing Address - Fax:
Practice Address - Street 1:75 WEST ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6528
Practice Address - Country:US
Practice Address - Phone:203-205-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional