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General NPI Number Information
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NPI Number | 1386712636
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Entity Type | Individual
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Provider Name | ELIZABETH FREEMAN YOUNG EDD
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Gender | Female
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 840 WINTER ST
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City | WALTHAM
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State | MA
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Zip | 02451-1433
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Country | US
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Telephone | 781-890-8226
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Fax |
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Provider Business Mailing Address
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Address Line | 107 PARKER AVE
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City | NEWTON
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State | MA
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Zip | 02461-1814
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Country | US
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Telephone | 617-953-9285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4216
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number | 4216
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License Number State | MA
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