Provider Demographics
NPI:1346336278
Name:MAWOD, JULIE LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LEE
Last Name:MAWOD
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 1:14379 OLD CAZADERO RD
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-9002
Mailing Address - Country:US
Mailing Address - Phone:707-604-7878
Mailing Address - Fax:
Practice Address - Street 1:14379 OLD CAZADERO RD
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-9002
Practice Address - Country:US
Practice Address - Phone:707-604-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA941711490OtherSOCIAL ADVOCATES FOR YOUTH