Provider Demographics
NPI:1831636745
Name:MARTZALL, JULIE (LSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MARTZALL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W SHORTCUT RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8721
Mailing Address - Country:US
Mailing Address - Phone:717-567-3524
Mailing Address - Fax:717-567-3581
Practice Address - Street 1:5377 LIBERTY VALLEY RD
Practice Address - Street 2:
Practice Address - City:ICKESBURG
Practice Address - State:PA
Practice Address - Zip Code:17037-9566
Practice Address - Country:US
Practice Address - Phone:717-724-7631
Practice Address - Fax:717-438-3735
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123738104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker