Provider Demographics
NPI:1326513961
Name:PRESENT KOLLER, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PRESENT KOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 RYDAL RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1216
Mailing Address - Country:US
Mailing Address - Phone:650-996-1757
Mailing Address - Fax:
Practice Address - Street 1:2043 LOCUST ST FL 1A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5662
Practice Address - Country:US
Practice Address - Phone:610-816-0031
Practice Address - Fax:215-600-3525
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018656103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical