Provider Demographics
NPI:1982616371
Name:SANDERS, JULIE CHARISSE (LICSW)
Entity Type:Individual
Prefix:
First Name:JULIE CHARISSE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:CHARISSE
Other - Last Name:COCKRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1211 GAR HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4225
Mailing Address - Country:US
Mailing Address - Phone:508-876-2172
Mailing Address - Fax:508-673-3182
Practice Address - Street 1:1211 GAR HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4225
Practice Address - Country:US
Practice Address - Phone:508-876-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1190811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJC31044Medicaid
MA110157012AMedicaid
RI215279OtherBLUE CROSS
RI410559OtherBLUE CHIP
RIJC31044Medicaid