Provider Demographics
NPI:1316203466
Name:CANFIELD, JULIE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:M
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 RIVERS EDGE DR
Mailing Address - Street 2:STE 140
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235
Mailing Address - Country:US
Mailing Address - Phone:614-578-0718
Mailing Address - Fax:
Practice Address - Street 1:7650 RIVERS EDGE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1342
Practice Address - Country:US
Practice Address - Phone:614-578-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6880103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical