Provider Demographics
NPI:1457479628
Name:BLODGETT, JULIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:A
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 EMMET STREET, SOUTH
Mailing Address - Street 2:P.O. BOX 400270
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22904-4270
Mailing Address - Country:US
Mailing Address - Phone:434-924-7034
Mailing Address - Fax:434-924-4621
Practice Address - Street 1:417 EMMET STREET, SOUTH
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22904-4270
Practice Address - Country:US
Practice Address - Phone:434-924-7034
Practice Address - Fax:434-924-4621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007709846Medicaid
VA113188OtherANTHEM BCBS OF VA
VA262856000OtherMAGELLAN
VAQ44775AMedicare PIN