Healthcare Provider Details

I. General information

NPI: 1912095761
Provider Name (Legal Business Name): MARY YOUNG SA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LINCOLN ST STE 309
FRAMINGHAM MA
01702-8264
US

IV. Provider business mailing address

61 LINCOLN ST STE 309
FRAMINGHAM MA
01702-8264
US

V. Phone/Fax

Practice location:
  • Phone: 612-655-3942
  • Fax:
Mailing address:
  • Phone: 612-655-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10871
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1527
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY-RXC0068
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4378
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: