Provider Demographics
NPI:1679750806
Name:KUSTRA, JULIA A (MSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:A
Last Name:KUSTRA
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 COLLINGWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1652
Mailing Address - Country:US
Mailing Address - Phone:419-243-9178
Mailing Address - Fax:
Practice Address - Street 1:2149 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1652
Practice Address - Country:US
Practice Address - Phone:419-243-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00017451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical