Healthcare Provider Details

I. General information

NPI: 1487611489
Provider Name (Legal Business Name): ALEXANDER STUART YOUNG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 3RD ST SUITE 3
NEPTUNE BEACH FL
32266-5131
US

IV. Provider business mailing address

302 3RD ST SUITE 3
NEPTUNE BEACH FL
32266-5131
US

V. Phone/Fax

Practice location:
  • Phone: 904-241-0666
  • Fax: 904-241-0289
Mailing address:
  • Phone: 904-241-0666
  • Fax: 904-241-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY002703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: