MEDICARE: MR. JACOB YOUNG-JAE HOYT MSW

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	P020691	NC

General Provider Information

NPI Number	:	1114763356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB YOUNG-JAE HOYT MSW

Provider Business Mailing Address
First Line	:	4429 LORD JOSEPH CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-8741
Country	:	US
Telephone Number	:	240-818-1214
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 CAPCOM AVE STE 104
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6514
Country	:	US
Telephone Number	:	984-207-3554
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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