Provider Demographics
NPI:1932286697
Name:EVELEIGH, JULIE S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:S
Last Name:EVELEIGH
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 1:8972 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14469-9523
Mailing Address - Country:US
Mailing Address - Phone:585-624-5380
Mailing Address - Fax:
Practice Address - Street 1:8972 BAKER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NY
Practice Address - Zip Code:14469-9523
Practice Address - Country:US
Practice Address - Phone:585-624-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041493-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103476FKOtherPREFERRED CARE
NYPO10041493OtherEXCELLUS PROVIDER NUMBER
NYDD4031Medicare ID - Type Unspecified
NYPO10041493OtherEXCELLUS PROVIDER NUMBER