Provider Demographics
NPI:1912529561
Name:PROCK, JULIA HEATHER
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:HEATHER
Last Name:PROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JULIA
Other - Middle Name:HEATHER
Other - Last Name:CUTLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 PENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2512
Mailing Address - Country:US
Mailing Address - Phone:330-253-3100
Mailing Address - Fax:
Practice Address - Street 1:87 CONSERVATORY DR
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4291
Practice Address - Country:US
Practice Address - Phone:234-334-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHS.2208235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101YA400XMedicaid