MEDICARE: LISA MARIE YOUNG

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	SW10096	FL
2	101YM0800X	Mental Health Counselor	SW10096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972170926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE YOUNG

Provider Business Mailing Address
First Line	:	3270 FRESNO AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-8348
Country	:	US
Telephone Number	:	321-591-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	3270 FRESNO AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-8348
Country	:	US
Telephone Number	:	321-591-4551
Fax Number	:

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

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	08/12/2022

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Directions to “ LISA MARIE YOUNG ” Practice Location

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