Healthcare Provider Details

I. General information

NPI: 1205956273
Provider Name (Legal Business Name): GLORIA YOUNG LCSW PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E MAIN ST
SEARSPORT ME
04974-3103
US

IV. Provider business mailing address

330 E MAIN ST
SEARSPORT ME
04974-3103
US

V. Phone/Fax

Practice location:
  • Phone: 207-548-6582
  • Fax:
Mailing address:
  • Phone: 207-548-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC3065
License Number StateME

VIII. Authorized Official

Name: MS. GLORIA YOUNG
Title or Position: SUL PROPRIETOR
Credential: LCSW
Phone: 207-548-6582