Provider Demographics
NPI:1225391394
Name:CARLEY, JULIA (LDN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CARLEY
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 SAN MARCO RD PH 8
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6745
Mailing Address - Country:US
Mailing Address - Phone:239-682-9569
Mailing Address - Fax:239-354-4308
Practice Address - Street 1:8340 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3625
Practice Address - Country:US
Practice Address - Phone:239-348-4560
Practice Address - Fax:239-354-4308
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4092133NN1002X
133V00000X
FLIMH15202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15202OtherFLORIDA BOARD OF MENTAL HEALTH COUNSELING