Provider Demographics
NPI:1891040549
Name:YOUNG, DMITRI AARON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DMITRI
Middle Name:AARON
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W GRAND AVE
Mailing Address - Street 2:#2
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3461
Mailing Address - Country:US
Mailing Address - Phone:619-203-5535
Mailing Address - Fax:
Practice Address - Street 1:2727 MARIPOSA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1472
Practice Address - Country:US
Practice Address - Phone:619-203-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical