Provider Demographics
NPI:1437391364
Name:YOUNG, JARED LEE (PSYD)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CENTRAL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4212
Mailing Address - Country:US
Mailing Address - Phone:717-606-3796
Mailing Address - Fax:717-367-9279
Practice Address - Street 1:51 CENTRAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4212
Practice Address - Country:US
Practice Address - Phone:717-606-3796
Practice Address - Fax:717-367-9279
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0142651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA150589Medicare Oscar/Certification