Provider Demographics
NPI:1760637144
Name:PARK, JULIA (PSY)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E BASIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4214
Mailing Address - Country:US
Mailing Address - Phone:302-449-3602
Mailing Address - Fax:
Practice Address - Street 1:318 E BASIN RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4214
Practice Address - Country:US
Practice Address - Phone:302-449-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE45583103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool