Provider Demographics
NPI:1679257810
Name:TIRELLA, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TIRELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20000 E COUNTRY CLUB DR APT 412
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3007
Mailing Address - Country:US
Mailing Address - Phone:305-761-6181
Mailing Address - Fax:
Practice Address - Street 1:20000 E COUNTRY CLUB DR APT 412
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-3007
Practice Address - Country:US
Practice Address - Phone:305-761-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLSW216162255A2300X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer