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General NPI Number Information
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NPI Number | 1013619709
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Entity Type | Organization
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Legal Business Name | MIRELLA YOUNG PSYD LLC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 175 DWIGHT RD STE 303-B
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City | LONGMEADOW
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State | MA
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Zip | 01106-1576
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Country | US
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Telephone | 413-345-2588
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 161
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City | LUDLOW
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State | MA
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Zip | 01056-0161
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Country | US
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Telephone | 413-345-2588
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. MIRELLA YOUNG
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Credential | PSY.D.
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Telephone | 413-345-2588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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