Provider Demographics
NPI:1770193708
Name:ANGSTADT, JULIE A (MA, LBS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:ANGSTADT
Suffix:
Gender:F
Credentials:MA, LBS
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:BLECHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 VALENTINE ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-2812
Mailing Address - Country:US
Mailing Address - Phone:732-832-9741
Mailing Address - Fax:
Practice Address - Street 1:605 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-2812
Practice Address - Country:US
Practice Address - Phone:732-832-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB455459103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103793292-0001Medicaid