Basic Information
| Provider Information | |||||||||
| NPI: | 1740400845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | L. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 WISSAHICKON AVE | ||||||||
| Address2: | SUITE 118 BOX 110 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191444248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158439720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3205 DEFENSE TERRACE | ||||||||
| Address2: | ABBOTTSFORD FAMILY PRACTICE & COUNSELING | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158439720 | ||||||||
| FaxNumber: | 2158437313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS016165 | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.