Provider Demographics
NPI:1053537530
Name:YOUNG, AMY B (PSYD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:B
Other - Last Name:BOLLENBACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MS, LPC
Mailing Address - Street 1:280 N PROVIDENCE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3527
Mailing Address - Country:US
Mailing Address - Phone:610-529-1875
Mailing Address - Fax:610-565-5874
Practice Address - Street 1:280 N PROVIDENCE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3527
Practice Address - Country:US
Practice Address - Phone:610-529-1875
Practice Address - Fax:610-565-5874
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016397103T00000X
PAPC000377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional