Provider Demographics
NPI:1396572749
Name:YOUNG, MARY (BSED)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 GREEN ACRES LOOP
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-5927
Mailing Address - Country:US
Mailing Address - Phone:304-910-9770
Mailing Address - Fax:
Practice Address - Street 1:340 GREEN ACRES LOOP
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24739-5927
Practice Address - Country:US
Practice Address - Phone:304-910-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency