Provider Demographics
NPI:1619278207
Name:BARBOZA, JULISSA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULISSA
Middle Name:M
Last Name:BARBOZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULISSA
Other - Middle Name:M
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 VALITA DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6129
Mailing Address - Country:US
Mailing Address - Phone:510-329-3787
Mailing Address - Fax:
Practice Address - Street 1:19000 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0712
Practice Address - Country:US
Practice Address - Phone:408-366-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS264551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical