Provider Demographics
NPI:1407001670
Name:DISNEY, JULIE (LSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DISNEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2140
Mailing Address - Country:US
Mailing Address - Phone:740-532-7855
Mailing Address - Fax:740-532-0557
Practice Address - Street 1:1518 S 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2140
Practice Address - Country:US
Practice Address - Phone:740-532-7855
Practice Address - Fax:740-532-0557
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS . 0019289104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker