Provider Demographics
NPI:1316412794
Name:YOUNG, MAGGIE D (LADC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ELMCREST TER BSMT
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3986
Mailing Address - Country:US
Mailing Address - Phone:203-810-5202
Mailing Address - Fax:203-299-1743
Practice Address - Street 1:4 ELMCREST TER BSMT
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3986
Practice Address - Country:US
Practice Address - Phone:203-810-5202
Practice Address - Fax:203-299-1743
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1248101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty