Provider Demographics
NPI:1770024879
Name:JOHNSON-YOUNG, IRIS
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:JOHNSON-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 1:821 EASTERN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5943
Mailing Address - Country:US
Mailing Address - Phone:844-224-5264
Mailing Address - Fax:
Practice Address - Street 1:426 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2446
Practice Address - Country:US
Practice Address - Phone:844-224-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22345104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker