MEDICARE: JULIE SUTTON LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	12081	MD

General Provider Information

NPI Number	:	1285492728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE SUTTON LCSW-C

Provider Business Mailing Address
First Line	:	PO BOX 93
Second Line	:
City	:	BUTLER
State	:	MD
Zip	:	21023-0093
Country	:	US
Telephone Number	:	410-654-4767
Fax Number	:

Provider Business Practice Location Address
First Line	:	9511 TESSA LN
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3276
Country	:	US
Telephone Number	:	410-654-4767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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