Healthcare Provider Details

I. General information

NPI: 1306834536
Provider Name (Legal Business Name): PAUL YOUNGS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 RHOADS AVE
NEWTOWN SQUARE PA
19073-3702
US

IV. Provider business mailing address

3536 RHOADS AVE
NEWTOWN SQUARE PA
19073-3702
US

V. Phone/Fax

Practice location:
  • Phone: 610-325-7115
  • Fax: 610-325-7115
Mailing address:
  • Phone: 610-325-7115
  • Fax: 610-325-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS-004980-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: