Provider Demographics
NPI:1851611610
Name:YOUNGERMAN, MARCIA ELYSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ELYSE
Last Name:YOUNGERMAN
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 1:878 AMELIA CT NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2784
Mailing Address - Country:US
Mailing Address - Phone:727-204-2897
Mailing Address - Fax:
Practice Address - Street 1:878 AMELIA CT NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2784
Practice Address - Country:US
Practice Address - Phone:727-204-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW4234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health