Healthcare Provider Details

I. General information

NPI: 1952257644
Provider Name (Legal Business Name): MAKENNA YOUNGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MORTON ST
JAMAICA PLAIN MA
02130-3735
US

IV. Provider business mailing address

170 MORTON ST
JAMAICA PLAIN MA
02130-3735
US

V. Phone/Fax

Practice location:
  • Phone: 617-318-5600
  • Fax: 617-983-4917
Mailing address:
  • Phone: 617-318-5600
  • Fax: 617-983-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: