Healthcare Provider Details

I. General information

NPI: 1770669350
Provider Name (Legal Business Name): CHRISTOPHER JOHN YOUNG LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 FRONT ST SUITE 306
SCITUATE MA
02066-1386
US

IV. Provider business mailing address

132 FRONT ST SUITE 306
SCITUATE MA
02066-1386
US

V. Phone/Fax

Practice location:
  • Phone: 781-545-1008
  • Fax: 781-545-1668
Mailing address:
  • Phone: 781-545-1008
  • Fax: 781-545-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105482
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPO3711
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS / BLUE SHIELD
# 2
Identifier459158
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH CARE
# 3
Identifier839789946
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED BEHAVIORAL HEALTH
# 4
Identifier063521000
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMAGELLAN BEHAVIORAL CARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: