Provider Demographics
NPI:1912380023
Name:YOUNG, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
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 1:1125 12TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3791
Mailing Address - Country:US
Mailing Address - Phone:772-925-8560
Mailing Address - Fax:772-925-8561
Practice Address - Street 1:1125 12TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3791
Practice Address - Country:US
Practice Address - Phone:772-925-8560
Practice Address - Fax:772-925-8561
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211786171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator