Provider Demographics
NPI:1447136940
Name:YOUNG, JOSEPH ROGER
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ROGER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 ANDRESS RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44814-9594
Mailing Address - Country:US
Mailing Address - Phone:917-447-2462
Mailing Address - Fax:
Practice Address - Street 1:5497 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-1386
Practice Address - Country:US
Practice Address - Phone:440-320-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1013563360OtherPRIVATE PRACTICE INSURANCE LINKAGE