Healthcare Provider Details

I. General information

NPI: 1306782156
Provider Name (Legal Business Name): MARLY YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39210 STATE ST STE 220
FREMONT CA
94538-1456
US

IV. Provider business mailing address

2473 BOOKSIN AVE
SAN JOSE CA
95125-4814
US

V. Phone/Fax

Practice location:
  • Phone: 408-772-3775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number46-1305562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: