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General NPI Number Information
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NPI Number | 1942668470
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Entity Type | Organization
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Legal Business Name | JANICE G. YOUNG, PH.D.
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 6417 GRAND POINT AVE
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City | UNIVERSITY PARK
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State | FL
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Zip | 34201-2122
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Country | US
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Telephone | 941-360-3384
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Fax | 941-351-3411
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Provider Business Mailing Address
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Address Line | 6417 GRAND POINT AVE
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City | UNIVERSITY PARK
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State | FL
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Zip | 34201-2122
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Country | US
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Telephone | 941-360-3384
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Fax | 941-351-3411
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JANICE G YOUNG
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Credential | PH.D.
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Telephone | 941-360-3384
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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 | PY6843
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License Number State | FL
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