MEDICARE: KENNETH GEORGE YOUNG LCSW

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	1041C0700X	Clinical Social Worker	CW016033	PA

General Provider Information

NPI Number	:	1972742112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH GEORGE YOUNG LCSW

Provider Business Mailing Address
First Line	:	107 SEA ISLE DR
Second Line	:
City	:	INDIAN BEACH
State	:	NC
Zip	:	28512-5939
Country	:	US
Telephone Number	:	267-970-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 SEA ISLE DR
Second Line	:
City	:	INDIAN BEACH
State	:	NC
Zip	:	28512-5939
Country	:	US
Telephone Number	:	267-970-9355
Fax Number	:

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

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	06/14/2023

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