MEDICARE: MS. ELIZABETH D. YOUNG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	976	LA

General Provider Information

NPI Number	:	1093870396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH D. YOUNG LCSW

Provider Business Mailing Address
First Line	:	228 MONTROSE AVE
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3822
Country	:	US
Telephone Number	:	337-981-9601
Fax Number	:	337-993-3481

Provider Business Practice Location Address
First Line	:	228 MONTROSE AVE
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3822
Country	:	US
Telephone Number	:	337-981-9601
Fax Number	:	337-993-3481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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