Healthcare Provider Details

I. General information

NPI: 1790821379
Provider Name (Legal Business Name): DOMINIQUE J STEVENS-YOUNG MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 DOROTHY DR
PENN HILLS PA
15235-1831
US

IV. Provider business mailing address

371 DOROTHY DR
PENN HILLS PA
15235-1831
US

V. Phone/Fax

Practice location:
  • Phone: 412-583-7892
  • Fax: 412-241-5509
Mailing address:
  • Phone: 412-583-7892
  • Fax: 412-241-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015959
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier411414
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCCBHO
# 2
IdentifierPENDING
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK
# 3
Identifier1016115230001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
IdentifierPENDING
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPROMISE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: