Provider Demographics
NPI:1821865478
Name:YOUNG, BRENDA GLENDENA
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:GLENDENA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:G
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5815 MARLBORO PIKE APT 102
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1130
Mailing Address - Country:US
Mailing Address - Phone:240-229-5082
Mailing Address - Fax:
Practice Address - Street 1:5815 MARLBORO PIKE APT 102
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-1130
Practice Address - Country:US
Practice Address - Phone:240-229-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty