Provider Demographics
NPI:1558935825
Name:URSIC, JULIE ROSE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ROSE
Last Name:URSIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ROSE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2183 W PASEO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4556
Mailing Address - Country:US
Mailing Address - Phone:310-421-8850
Mailing Address - Fax:
Practice Address - Street 1:2309 PACIFIC COAST HWY STE 202
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2753
Practice Address - Country:US
Practice Address - Phone:310-421-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1283551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program