Provider Demographics
NPI:1710686381
Name:PRITT, JULIE M (LPCA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:PRITT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 STATE ST APT 10J
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3121
Mailing Address - Country:US
Mailing Address - Phone:612-930-8090
Mailing Address - Fax:
Practice Address - Street 1:100 ELIZABETH ST FL 2
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1819
Practice Address - Country:US
Practice Address - Phone:203-446-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6156101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6156OtherCT DEPARTMENT OF PUBLIC HEALTH
CT6156Medicaid