Provider Demographics
NPI:1982090460
Name:PAULSON, JULIA (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PAULSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:BEMUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14712-9747
Mailing Address - Country:US
Mailing Address - Phone:716-272-2208
Mailing Address - Fax:716-332-2820
Practice Address - Street 1:4125 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:BEMUS POINT
Practice Address - State:NY
Practice Address - Zip Code:14712-9747
Practice Address - Country:US
Practice Address - Phone:716-272-2208
Practice Address - Fax:716-332-2820
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00076663104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04156209Medicaid