Healthcare Provider Details

I. General information

NPI: 1699095893
Provider Name (Legal Business Name): ANGELA L YOUNG LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 BALLOON PARK RD NE
ALBUQUERQUE NM
87109-5801
US

IV. Provider business mailing address

4216 BALLOON PARK RD NE
ALBUQUERQUE NM
87109-5801
US

V. Phone/Fax

Practice location:
  • Phone: 505-889-3412
  • Fax: 505-889-3422
Mailing address:
  • Phone: 505-889-3412
  • Fax: 505-889-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2024-1089
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: