Provider Demographics
NPI:1184094740
Name:YOUNG, JENNIFER MARIE (LICSW)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GLENNON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-5268
Mailing Address - Country:US
Mailing Address - Phone:781-915-4596
Mailing Address - Fax:
Practice Address - Street 1:167 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743-2778
Practice Address - Country:US
Practice Address - Phone:774-634-0066
Practice Address - Fax:774-202-4733
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2195141041C0700X
MA1198851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical