MEDICARE: MS. MERRA L. YOUNG MSW,LICSW,LMFT

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	02023	MN

General Provider Information

NPI Number	:	1215110168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MERRA L. YOUNG MSW,LICSW,LMFT

Provider Business Mailing Address
First Line	:	2637 27TH AVE S
Second Line	:	#201 (RIVERS' WAY)
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-253-5133
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 27TH AVE S
Second Line	:	#201 (RIVERS' WAY)
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-253-5133
Fax Number	:

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

Provider Enumeration Date	:	12/14/2007
Last Update Date	:	12/14/2007

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