Provider Demographics
NPI:1457479313
Name:DZIKI, JULIE THERESA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:THERESA
Last Name:DZIKI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 CANAL STREET
Mailing Address - Street 2:SUITE 1 EAST
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1233
Mailing Address - Country:US
Mailing Address - Phone:978-686-8202
Mailing Address - Fax:978-686-6162
Practice Address - Street 1:599 CANAL STREET
Practice Address - Street 2:SUITE 1 EAST
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1233
Practice Address - Country:US
Practice Address - Phone:978-686-8202
Practice Address - Fax:978-686-6162
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1162871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health