Healthcare Provider Details

I. General information

NPI: 1386712636
Provider Name (Legal Business Name): ELIZABETH FREEMAN YOUNG EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WINTER ST
WALTHAM MA
02451-1433
US

IV. Provider business mailing address

107 PARKER AVE
NEWTON MA
02461-1814
US

V. Phone/Fax

Practice location:
  • Phone: 781-890-8226
  • Fax:
Mailing address:
  • Phone: 617-953-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4216
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number4216
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: