Provider Demographics
NPI:1669131793
Name:LEWIS, JULIE KATELIN (LICSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KATELIN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATELIN
Other - Middle Name:
Other - Last Name:LEWIS-KULIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:50 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2804
Mailing Address - Country:US
Mailing Address - Phone:415-902-2007
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3259
Practice Address - Country:US
Practice Address - Phone:413-707-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1244491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical