Provider Demographics
NPI:1013438084
Name:CRIVELLO, JULIA KRISTIN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KRISTIN
Last Name:CRIVELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:KRISTIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 N MAYFAIR RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2262
Mailing Address - Country:US
Mailing Address - Phone:414-939-9390
Mailing Address - Fax:414-939-9383
Practice Address - Street 1:2222 N MAYFAIR RD STE 120
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2262
Practice Address - Country:US
Practice Address - Phone:414-939-9390
Practice Address - Fax:414-939-9383
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4285-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional