Healthcare Provider Details

I. General information

NPI: 1205133675
Provider Name (Legal Business Name): JESSICA ANNE YOUNG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 EUCLID AVE #102
SAN DIEGO CA
92114-3610
US

IV. Provider business mailing address

286 EUCLID AVE #102
SAN DIEGO CA
92114-3610
US

V. Phone/Fax

Practice location:
  • Phone: 619-266-2111
  • Fax: 619-266-0496
Mailing address:
  • Phone: 619-266-2111
  • Fax: 619-266-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: