Provider Demographics
NPI:1851574479
Name:KELLEY, JULIETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIETTE
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TAYLOR BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2287
Mailing Address - Country:US
Mailing Address - Phone:925-325-1427
Mailing Address - Fax:
Practice Address - Street 1:399 TAYLOR BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2287
Practice Address - Country:US
Practice Address - Phone:925-325-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA724911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical