Provider Demographics
NPI:1952522245
Name:DEMEZA, JULIE (LISW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DEMEZA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 RED FERN CIR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2092
Mailing Address - Country:US
Mailing Address - Phone:330-677-0457
Mailing Address - Fax:
Practice Address - Street 1:520 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2218
Practice Address - Country:US
Practice Address - Phone:330-296-5552
Practice Address - Fax:330-296-6126
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0015451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional