Provider Demographics
NPI:1700173838
Name:FAIRCLOUGH, JULIA (LICSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:FAIRCLOUGH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KINGMAN RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3312
Mailing Address - Country:US
Mailing Address - Phone:617-650-6874
Mailing Address - Fax:
Practice Address - Street 1:750 WINTER ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5665
Practice Address - Country:US
Practice Address - Phone:508-416-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool