Provider Demographics
NPI:1407691454
Name:YOUNG, JENNIFER (CRPS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:YOUNG
Suffix:
Gender:
Credentials:CRPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 GECK RD
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-9619
Mailing Address - Country:US
Mailing Address - Phone:386-336-8139
Mailing Address - Fax:
Practice Address - Street 1:156 GECK RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-9619
Practice Address - Country:US
Practice Address - Phone:386-336-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW201501041C0700X
FLCRPS.0100637.F175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical