Provider Demographics
NPI:1730471707
Name:YOUNG, BROOKE ALISON
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ALISON
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:MARION HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:17832-0198
Mailing Address - Country:US
Mailing Address - Phone:570-259-0276
Mailing Address - Fax:
Practice Address - Street 1:129 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2175
Practice Address - Country:US
Practice Address - Phone:570-339-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11600386103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool