Provider Demographics
NPI:1457477986
Name:GERHARDT, JULIA PENELOPE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:PENELOPE
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:PENELOPE
Other - Last Name:MAER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6283 N OLIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2070
Mailing Address - Country:US
Mailing Address - Phone:208-343-6485
Mailing Address - Fax:
Practice Address - Street 1:6550 W EMERALD ST
Practice Address - Street 2:STE 110
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8780
Practice Address - Country:US
Practice Address - Phone:208-297-8585
Practice Address - Fax:208-965-8512
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW256751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical