Provider Demographics
NPI:1629338702
Name:BUSH, JULIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:BUSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:FRANGIONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:482 BLACK RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2416
Mailing Address - Country:US
Mailing Address - Phone:315-782-1777
Mailing Address - Fax:315-785-8628
Practice Address - Street 1:604 PINE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3236
Practice Address - Country:US
Practice Address - Phone:315-286-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078942-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical