Provider Demographics
NPI:1912368515
Name:CLIFTON, JULIE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:KONKOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 410377
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-0377
Mailing Address - Country:US
Mailing Address - Phone:321-752-3170
Mailing Address - Fax:
Practice Address - Street 1:326 CROTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6340
Practice Address - Country:US
Practice Address - Phone:321-752-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 119071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical