Provider Demographics
NPI:1912437542
Name:PAGE, JULIA BRAISTED
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:BRAISTED
Last Name:PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LANZ LN
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2312
Mailing Address - Country:US
Mailing Address - Phone:203-448-8402
Mailing Address - Fax:
Practice Address - Street 1:30 LANZ LN
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2312
Practice Address - Country:US
Practice Address - Phone:203-448-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical