Provider Demographics
NPI:1841851771
Name:VAUGHN, JULIA RENEE (BSW, MSW)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:RENEE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:BSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25823 VAN LEUVEN ST APT 153
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2554
Mailing Address - Country:US
Mailing Address - Phone:951-250-6782
Mailing Address - Fax:
Practice Address - Street 1:25823 VAN LEUVEN ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2554
Practice Address - Country:US
Practice Address - Phone:951-441-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical