Provider Demographics
NPI:1477626752
Name:BLEICKER, JULIE ELAINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ELAINE
Last Name:BLEICKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1303
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95009-1303
Mailing Address - Country:US
Mailing Address - Phone:408-522-2516
Mailing Address - Fax:408-774-2355
Practice Address - Street 1:21370 HOMESTEAD RD.
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-522-2516
Practice Address - Fax:408-774-2355
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS211091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4018OtherCOUNTY ISSUED NUMBER