Provider Demographics
NPI:1356467633
Name:JULIAN, PATRICIA (LADC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:JULIAN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04223-0134
Mailing Address - Country:US
Mailing Address - Phone:207-420-2429
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5811
Practice Address - Country:US
Practice Address - Phone:207-420-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3777101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432464299Medicaid