Provider Demographics
NPI:1366115180
Name:JENNIFE RYOUNG, PH.D.
Entity type:Organization
Organization Name:JENNIFE RYOUNG, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-249-0594
Mailing Address - Street 1:114 BESECKER DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-7891
Mailing Address - Country:US
Mailing Address - Phone:570-249-0594
Mailing Address - Fax:
Practice Address - Street 1:47 S COURTLAND ST STE 2
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2872
Practice Address - Country:US
Practice Address - Phone:570-249-0594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty