MEDICARE: DR. ANDREA YOUNG PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	7220	OH
2	103TC0700X	Clinical Psychologist	05659	MD

General Provider Information

NPI Number	:	1407234016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA YOUNG PH.D.

Provider Business Mailing Address
First Line	:	716 N BROADWAY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 N BROADWAY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1806
Country	:	US
Telephone Number	:	443-923-7600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	12/17/2015

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