Healthcare Provider Details

I. General information

NPI: 1730024894
Provider Name (Legal Business Name): FREDRICK YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3529 FISHER HILL RD
LAUREL MD
20724-1425
US

IV. Provider business mailing address

3529 FISHER HILL RD
LAUREL MD
20724-1425
US

V. Phone/Fax

Practice location:
  • Phone: 661-545-9306
  • Fax:
Mailing address:
  • Phone: 661-545-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: