Provider Demographics
NPI:1013619709
Name:MIRELLA YOUNG PSYD LLC
Entity Type:Organization
Organization Name:MIRELLA YOUNG PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:413-345-2588
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0161
Mailing Address - Country:US
Mailing Address - Phone:413-345-2588
Mailing Address - Fax:
Practice Address - Street 1:175 DWIGHT RD STE 303-B
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1576
Practice Address - Country:US
Practice Address - Phone:413-345-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty