Provider Demographics
NPI:1619267010
Name:CHIARADONNA, JULEEN ANN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:JULEEN
Middle Name:ANN
Last Name:CHIARADONNA
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARKET PLACE DR
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1698
Mailing Address - Country:US
Mailing Address - Phone:603-387-4388
Mailing Address - Fax:603-522-8768
Practice Address - Street 1:4 MARKET PLACE DR
Practice Address - Street 2:SUITE 202A
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1698
Practice Address - Country:US
Practice Address - Phone:603-387-4388
Practice Address - Fax:603-522-8768
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC133601041C0700X
NH14401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1619267010Medicaid
003014301OtherMEDICARE PTAN