Provider Demographics
NPI:1023673563
Name:YOUNG, ROBERT E (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 N WATER ST STE 712
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4104
Mailing Address - Country:US
Mailing Address - Phone:414-888-4287
Mailing Address - Fax:414-888-4290
Practice Address - Street 1:735 N WATER ST STE 712
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4104
Practice Address - Country:US
Practice Address - Phone:414-888-4287
Practice Address - Fax:414-888-4290
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2216-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical