Healthcare Provider Details

I. General information

NPI: 1639571904
Provider Name (Legal Business Name): EMMA M YOUNG LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DEER HL N
STANDISH ME
04084-6367
US

IV. Provider business mailing address

25 DEER HL N
STANDISH ME
04084-6367
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-4234
  • Fax:
Mailing address:
  • Phone: 178-153-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC5736
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: