Provider Demographics
NPI:1790821379
Name:STEVENS-YOUNG, DOMINIQUE J (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:J
Last Name:STEVENS-YOUNG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:PENN HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15235-1831
Mailing Address - Country:US
Mailing Address - Phone:412-583-7892
Mailing Address - Fax:412-241-5509
Practice Address - Street 1:371 DOROTHY DR
Practice Address - Street 2:
Practice Address - City:PENN HILLS
Practice Address - State:PA
Practice Address - Zip Code:15235-1831
Practice Address - Country:US
Practice Address - Phone:412-583-7892
Practice Address - Fax:412-241-5509
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0159591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA411414OtherCCBHO
PAPENDINGOtherHIGHMARK
PA1016115230001Medicaid
PAPENDINGOtherPROMISE