Healthcare Provider Details

I. General information

NPI: 1710370606
Provider Name (Legal Business Name): CHRISTOPHER YOUNG MSW, LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 10/30/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WELLINGTON PL
CINCINNATI OH
45219-1710
US

IV. Provider business mailing address

8350 TIDEWATER CT
CINCINNATI OH
45255-4468
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-0650
  • Fax:
Mailing address:
  • Phone: 513-630-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: