Individual
JOHN YOUNGBLOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
120 MAPLE ST, SUITE 219, SPRINGFIELD, MA 01103-2203
(413) 737-3730
Mailing address
34 CHESTNUT HILL RD, LEVERETT, MA 01054-9732
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1424
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0300050
MBHP
MA
05
—
1300881
—
MA
Enumeration date
03/29/2007
Last updated
07/08/2007
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