Provider Demographics
NPI:1851606552
Name:YOUNG, HERMAN PURNELL (LICSW-C)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:PURNELL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LICSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 SUPRA PL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3523
Mailing Address - Country:US
Mailing Address - Phone:301-486-0976
Mailing Address - Fax:301-486-1901
Practice Address - Street 1:4710 PENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21226-1444
Practice Address - Country:US
Practice Address - Phone:410-878-7030
Practice Address - Fax:410-800-4871
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCSW-C 075931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical