Provider Demographics
NPI:1285067207
Name:YOUNG, STEPHANIE (PHD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2827 CONCORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2608
Mailing Address - Country:US
Mailing Address - Phone:925-685-9670
Mailing Address - Fax:
Practice Address - Street 1:2827 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2608
Practice Address - Country:US
Practice Address - Phone:925-685-9670
Practice Address - Fax:925-685-1528
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32569OtherCA BOARD OF PSYCHOLOGY LICENSE