Provider Demographics
NPI:1932559069
Name:PRENTICE, JULIA (CPS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 CRESTA WAY
Mailing Address - Street 2:#6
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-5573
Mailing Address - Country:US
Mailing Address - Phone:860-205-4714
Mailing Address - Fax:
Practice Address - Street 1:920 CRESTA WAY
Practice Address - Street 2:#6
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-5573
Practice Address - Country:US
Practice Address - Phone:860-205-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health