Provider Demographics
NPI:1821116344
Name:YOUNG, JOANNE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BAY AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:831-476-1243
Mailing Address - Fax:831-479-9048
Practice Address - Street 1:820 BAY AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010
Practice Address - Country:US
Practice Address - Phone:831-462-1849
Practice Address - Fax:831-479-9048
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
R22787Medicare UPIN
CAZZZ37258ZMedicare ID - Type Unspecified