Provider Demographics
NPI:1982225033
Name:KAMENETSKY, JULIA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:MICHELLE
Last Name:KAMENETSKY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 DEXTER ST.
Mailing Address - Street 2:1 FRONT
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2494
Mailing Address - Country:US
Mailing Address - Phone:312-480-9547
Mailing Address - Fax:
Practice Address - Street 1:1155 WESTMINSTER ST STE 206
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1140
Practice Address - Country:US
Practice Address - Phone:401-365-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical