Active NPI
Krysta Jean Young, ACSW
- Clinical Social Worker
- San Jacinto, CA
National Provider Identifier
1922533561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- ASW120101
- Practice address
- 2220 Girard St
San Jacinto, CA 92583-5301 - Phone
- (952) 683-6596
- NPI assigned
- Apr 20, 2017
- Sex
- Female
- Sole proprietor
- No
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 Social Worker | 1041C0700X | ASW120101 | CA | Primary |
Addresses
Primary practice location
2220 Girard St
San Jacinto, CA 92583-5301
Mailing address
PO Box 1810
San Jacinto, CA 92581-1810
Phone (951) 292-1041
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW120101 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704844800000",
"number": "1922533561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1810",
"city": "SAN JACINTO",
"state": "CA",
"postal_code": "925811810",
"telephone_number": "951-292-1041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2220 GIRARD ST",
"city": "SAN JACINTO",
"state": "CA",
"postal_code": "925835301",
"telephone_number": "952-683-6596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "KRYSTA",
"middle_name": "JEAN",
"credential": "ACSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-20",
"last_updated": "2024-01-10",
"certification_date": "2024-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "ASW120101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jacinto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.