Provider Demographics
NPI:1659439073
Name:BEARD, JULIA WINIFRED (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:WINIFRED
Last Name:BEARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27941 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1535
Mailing Address - Country:US
Mailing Address - Phone:586-445-8730
Mailing Address - Fax:586-445-0626
Practice Address - Street 1:27941 HARPER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1535
Practice Address - Country:US
Practice Address - Phone:586-445-8730
Practice Address - Fax:586-445-0626
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISW 6801018476101YM0800X
MI68010184761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008924130OtherBCBSM
MI0892413Medicare ID - Type UnspecifiedPROVIDER ID NUIMBER