Healthcare Provider Details

I. General information

NPI: 1396280384
Provider Name (Legal Business Name): DENISE LANCASTER-YOUNG MSW, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 S HUGHES AVE
FRESNO CA
93706-2321
US

IV. Provider business mailing address

2550 W. CLINTON AVE
FRESNO CA
93705
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-8340
  • Fax:
Mailing address:
  • Phone: 559-264-7521
  • Fax: 559-441-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: