Provider Demographics
NPI:1770625329
Name:BERNSTEIN, JULIE GOTTLIEB (LMSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:GOTTLIEB
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:GOTTLIEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2020 RAYBROOK SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-285-6777
Mailing Address - Fax:616-285-6063
Practice Address - Street 1:2020 RAYBROOK SE
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-285-6777
Practice Address - Fax:616-285-6063
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801057671104100000X
MI68010089311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0890080Medicare PIN