Healthcare Provider Details

I. General information

NPI: 1568149755
Provider Name (Legal Business Name): BRUCE HENRY YOUNG PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 71ST RD
FOREST HILLS NY
11375-4848
US

IV. Provider business mailing address

10920 71ST RD APT 2F
FOREST HILLS NY
11375-4806
US

V. Phone/Fax

Practice location:
  • Phone: 408-679-1032
  • Fax:
Mailing address:
  • Phone: 408-679-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028420
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: