Provider Demographics
NPI:1144388281
Name:STASS, JULIE PATRICIA (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:PATRICIA
Last Name:STASS
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 5TH AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1685
Mailing Address - Country:US
Mailing Address - Phone:619-696-3300
Mailing Address - Fax:619-696-3315
Practice Address - Street 1:2445 5TH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1685
Practice Address - Country:US
Practice Address - Phone:619-696-3300
Practice Address - Fax:619-696-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 15828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health