Provider Demographics
NPI:1356131155
Name:LONGFELLOW, JULIE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:LONGFELLOW
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:KAWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW/ MSW
Mailing Address - Street 1:P.O. BOX 6098
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325
Mailing Address - Country:US
Mailing Address - Phone:909-213-1970
Mailing Address - Fax:
Practice Address - Street 1:23152 BROOKSIDE RD.
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325
Practice Address - Country:US
Practice Address - Phone:909-213-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1218431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical