Provider Demographics
NPI:1386616217
Name:YOUNG, JANICE G (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:G
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 GRAND POINT AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2122
Mailing Address - Country:US
Mailing Address - Phone:941-360-3384
Mailing Address - Fax:941-351-3411
Practice Address - Street 1:2801 FRUITVILLE RD
Practice Address - Street 2:STE.110
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5343
Practice Address - Country:US
Practice Address - Phone:941-360-3384
Practice Address - Fax:941-351-3411
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-04
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV60361Medicare ID - Type UnspecifiedPARTICIPATING PROVIDER
FL74075Medicare ID - Type UnspecifiedPARTICIPATING PROVIDER