Provider Demographics
NPI:1518295468
Name:BASULTO, JULIE M (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:BASULTO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18441 NW 2ND AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4517
Mailing Address - Country:US
Mailing Address - Phone:305-249-0521
Mailing Address - Fax:305-249-0523
Practice Address - Street 1:18441 NW 2ND AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4517
Practice Address - Country:US
Practice Address - Phone:305-249-0521
Practice Address - Fax:305-249-0523
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid