Provider Demographics
NPI:1952311573
Name:COLLINS, JULIEANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIEANNE
Middle Name:
Last Name:COLLINS
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 1:521 W CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4625
Mailing Address - Country:US
Mailing Address - Phone:909-335-5872
Mailing Address - Fax:909-739-9485
Practice Address - Street 1:521 W CITRUS AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4625
Practice Address - Country:US
Practice Address - Phone:909-335-5872
Practice Address - Fax:909-739-9485
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS147311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ2732ZMedicare ID - Type Unspecified