Provider Demographics
NPI:1689311193
Name:SIDES, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SIDES
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 1:7780 NW 78TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4726
Mailing Address - Country:US
Mailing Address - Phone:754-234-8711
Mailing Address - Fax:
Practice Address - Street 1:911 E ATLANTIC BLVD STE 108A
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7372
Practice Address - Country:US
Practice Address - Phone:954-941-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician