Provider Demographics
NPI:1356629554
Name:YOUNG-WOLFF, KELLY (MA)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:
Last Name:YOUNG-WOLFF
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 1:10 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3505
Mailing Address - Country:US
Mailing Address - Phone:310-490-6865
Mailing Address - Fax:
Practice Address - Street 1:10 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-3505
Practice Address - Country:US
Practice Address - Phone:310-490-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist