Basic Information
| Provider Information | |||||||||
| NPI: | 1750834073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNGMAN | ||||||||
| FirstName: | YIQING | ||||||||
| MiddleName: | MIAO | ||||||||
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| Credential: | PSY.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MIAO | ||||||||
| OtherFirstName: | YIQING | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20134 VALLEY FORGE CIR | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194061112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2675521012 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20134 VALLEY FORGE CIR | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194061112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108789330 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2016 | ||||||||
| LastUpdateDate: | 05/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS018962 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.