Healthcare Provider Details

I. General information

NPI: 1063635894
Provider Name (Legal Business Name): LINDA YOUNG LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GARRISON BLVD STE 150
BALTIMORE MD
21216-2316
US

IV. Provider business mailing address

4604 EMBASSY CIR APT 103
OWINGS MILLS MD
21117-6310
US

V. Phone/Fax

Practice location:
  • Phone: 410-233-3111
  • Fax: 410-233-3222
Mailing address:
  • Phone: 617-817-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19584
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: