Provider Demographics
NPI:1790070357
Name:PORATH, JULIE ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:PORATH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 BAY VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-9271
Mailing Address - Country:US
Mailing Address - Phone:612-875-2400
Mailing Address - Fax:
Practice Address - Street 1:10530 BAY VIEW LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9271
Practice Address - Country:US
Practice Address - Phone:612-875-2400
Practice Address - Fax:651-220-6393
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN158111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical