Healthcare Provider Details

I. General information

NPI: 1780065052
Provider Name (Legal Business Name): DENISE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE GIANINI

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 RED PAINT RD
MANCHESTER ME
04351-3930
US

IV. Provider business mailing address

PO BOX 35
MANCHESTER ME
04351-0035
US

V. Phone/Fax

Practice location:
  • Phone: 207-242-5047
  • Fax:
Mailing address:
  • Phone: 207-242-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC16716
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: