Provider Demographics
NPI:1871032714
Name:YOUNG, DALE
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 HOBART RD
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9723
Mailing Address - Country:US
Mailing Address - Phone:216-283-4400
Mailing Address - Fax:216-283-2099
Practice Address - Street 1:10026 HOBART RD
Practice Address - Street 2:
Practice Address - City:KIRTLAND
Practice Address - State:OH
Practice Address - Zip Code:44094-9723
Practice Address - Country:US
Practice Address - Phone:216-283-4400
Practice Address - Fax:216-283-2099
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0007247104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker