Provider Demographics
NPI:1386828085
Name:EDDY, JULIA GWENDOLYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:GWENDOLYN
Last Name:EDDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:GWENDOLYN
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1326 SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-4951
Mailing Address - Country:US
Mailing Address - Phone:510-219-9641
Mailing Address - Fax:
Practice Address - Street 1:2060 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1001
Practice Address - Country:US
Practice Address - Phone:925-551-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical