Provider Demographics
NPI:1760971139
Name:YOUNG, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
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 1:278 COREYS DR
Mailing Address - Street 2:
Mailing Address - City:MORETOWN
Mailing Address - State:VT
Mailing Address - Zip Code:05660-4467
Mailing Address - Country:US
Mailing Address - Phone:802-318-3566
Mailing Address - Fax:
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09925021104100000X
VT089.01343311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09925021OtherLICENSE NUMBER
VT089.0134331OtherVERMONT LICSW NUMBER