Individual
FANNY MARIELA YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 CONSTITUTION AVE APT 335, BAYONNE, NJ 07002-5083
(908) 358-3939
Mailing address
300 CONSTITUTION AVE APT 335, BAYONNE, NJ 07002-5083
(908) 358-3939
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
1041S0200X
School Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y68112597453792
DRIVERS LICENSE
NJ
Enumeration date
12/06/2021
Last updated
12/06/2021
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