Provider Demographics
NPI:1376289413
Name:MADISON, JULIA MARIE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:MARIE
Last Name:MADISON
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 1:290 LENOX AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4991
Mailing Address - Country:US
Mailing Address - Phone:646-906-3475
Mailing Address - Fax:929-552-1930
Practice Address - Street 1:290 LENOX AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4991
Practice Address - Country:US
Practice Address - Phone:646-906-3475
Practice Address - Fax:929-552-1930
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06587800104100000X
NJNJDCATEMP-0499081041C0700X
NY0933511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker