Provider Demographics
NPI:1205133675
Name:YOUNG, JESSICA ANNE (MSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:286 EUCLID AVE
Mailing Address - Street 2:#102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3610
Mailing Address - Country:US
Mailing Address - Phone:619-266-2111
Mailing Address - Fax:619-266-0496
Practice Address - Street 1:286 EUCLID AVE
Practice Address - Street 2:#102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3610
Practice Address - Country:US
Practice Address - Phone:619-266-2111
Practice Address - Fax:619-266-0496
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical