Provider Demographics
NPI:1083930994
Name:HUMPHRIES, JULIA (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:FLEMMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:99 CAROL ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8310
Mailing Address - Country:US
Mailing Address - Phone:203-554-0740
Mailing Address - Fax:
Practice Address - Street 1:431 POST RD E
Practice Address - Street 2:STE 14
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4403
Practice Address - Country:US
Practice Address - Phone:203-554-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0072831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039244Medicaid
CT387891OtherMHN