Provider Demographics
NPI:1487611489
Name:YOUNG, ALEXANDER STUART (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:STUART
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 3RD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-5131
Mailing Address - Country:US
Mailing Address - Phone:904-241-0666
Mailing Address - Fax:904-241-0289
Practice Address - Street 1:302 3RD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5131
Practice Address - Country:US
Practice Address - Phone:904-241-0666
Practice Address - Fax:904-241-0289
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY002703103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3634Medicare ID - Type Unspecified