Provider Demographics
NPI:1265516124
Name:YOUNG, ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-3417
Mailing Address - Country:US
Mailing Address - Phone:518-369-5788
Mailing Address - Fax:
Practice Address - Street 1:741 NORTH ST
Practice Address - Street 2:BRIEN FAMILY CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2145
Practice Address - Fax:413-447-3245
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002746-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA38196OtherHEALTH NEW ENGLAND