Provider Demographics
NPI:1245960020
Name:YOUNG, HEATHER L (CASAC-T)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:SOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1729 COUNTY ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:NY
Mailing Address - Zip Code:13697-3155
Mailing Address - Country:US
Mailing Address - Phone:315-664-4073
Mailing Address - Fax:
Practice Address - Street 1:159 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-2385
Practice Address - Country:US
Practice Address - Phone:518-891-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141536222324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility