Provider Demographics
NPI:1295974665
Name:YOUNG, FREDERICK
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 W IMPERIAL HWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-3143
Mailing Address - Country:US
Mailing Address - Phone:310-713-5299
Mailing Address - Fax:
Practice Address - Street 1:2930 W IMPERIAL HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-3143
Practice Address - Country:US
Practice Address - Phone:310-713-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical