Active NPI
Jennifer K. Youngstrom, PH.D
- Clinical Psychologist
- Durham, NC
National Provider Identifier
1487604765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3287
- Practice address
- 1316 Broad St
Durham, NC 27705-3533 - Phone
- (216) 410-5711
- NPI assigned
- May 10, 2006
- Last updated
- Oct 6, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3287 | NC | Primary |
Addresses
Primary practice location
1316 Broad St
Durham, NC 27705-3533
Mailing address
103 Westchester PL
Chapel Hill, NC 27514-5237
Phone (216) 410-5711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3287 | NC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633478400000",
"number": "1487604765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 WESTCHESTER PL",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275145237",
"telephone_number": "216-410-5711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1316 BROAD ST",
"city": "DURHAM",
"state": "NC",
"postal_code": "277053533",
"telephone_number": "216-410-5711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGSTROM",
"first_name": "JENNIFER",
"middle_name": "K.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-10",
"last_updated": "2021-10-06",
"certification_date": "2021-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "3287",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.