Provider Demographics
NPI:1578545042
Name:POWELL, JULIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:POWELL
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 1:330 CHANGEBRIDGE ROAD
Mailing Address - Street 2:101
Mailing Address - City:PINEBROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058
Mailing Address - Country:US
Mailing Address - Phone:917-449-6957
Mailing Address - Fax:
Practice Address - Street 1:330 CHANGEBRIDGE RD
Practice Address - Street 2:101
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9839
Practice Address - Country:US
Practice Address - Phone:917-449-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44052730001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical