Basic Information
| Provider Information | |||||||||
| NPI: | 1982155032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4040 WASHINGTON ST APT 4 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021311747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082776800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1685 BEACON ST STE 1C | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024454411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174674136 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2016 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 000221941 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 121515 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.