Provider Demographics
NPI:1679123152
Name:YOUNG, AMY L (MSED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 ROUTE 138 WEST
Mailing Address - Street 2:BUILDING 3 - SUITE 1
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9021
Mailing Address - Country:US
Mailing Address - Phone:908-360-2977
Mailing Address - Fax:
Practice Address - Street 1:3100 ROUTE 138 WEST
Practice Address - Street 2:BUILDING 3 - SUITE 1
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9021
Practice Address - Country:US
Practice Address - Phone:973-294-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00316800101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional