Provider Demographics
NPI:1104845130
Name:MADGWICK, JULIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MADGWICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7473 W LAKE MEAD BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0265
Mailing Address - Country:US
Mailing Address - Phone:702-947-4841
Mailing Address - Fax:702-562-1247
Practice Address - Street 1:7473 W LAKE MEAD BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0265
Practice Address - Country:US
Practice Address - Phone:702-947-4841
Practice Address - Fax:702-562-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01999-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical