Provider Demographics
NPI:1770472524
Name:AHYOUNG TAE, PSYD
Entity type:Organization
Organization Name:AHYOUNG TAE, PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AHYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:TAE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:267-688-2225
Mailing Address - Street 1:1315 WOLF ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2911
Mailing Address - Country:US
Mailing Address - Phone:267-688-2225
Mailing Address - Fax:
Practice Address - Street 1:1315 WOLF ST UNIT 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2911
Practice Address - Country:US
Practice Address - Phone:267-688-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health