Provider Demographics
NPI:1952402224
Name:JULIE ANN PETERSON, P.A.
Entity Type:Organization
Organization Name:JULIE ANN PETERSON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-739-2454
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-0633
Mailing Address - Country:US
Mailing Address - Phone:207-890-8779
Mailing Address - Fax:207-739-2453
Practice Address - Street 1:28 WINTER ST
Practice Address - Street 2:UNIT 2
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5620
Practice Address - Country:US
Practice Address - Phone:207-890-8779
Practice Address - Fax:207-739-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC81641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME11328070OtherCAQH PROVIDER NUMBER
ME27611000099Medicaid
ME27611000099Medicaid