MEDICARE: DR. JULIE M CANFIELD PSY.D.

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	103TC0700X	Clinical Psychologist	6880	OH
2	103TC2200X	Clinical Child & Adolescent Psychologist	6880	OH

General Provider Information

NPI Number	:	1316203466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE M CANFIELD PSY.D.

Provider Business Mailing Address
First Line	:	7650 RIVERS EDGE DR
Second Line	:	STE 140
City	:	COLUMBUS
State	:	OH
Zip	:	43235
Country	:	US
Telephone Number	:	614-578-0718
Fax Number	:

Provider Business Practice Location Address
First Line	:	7650 RIVERS EDGE DR
Second Line	:	SUITE 140
City	:	COLUMBUS
State	:	OH
Zip	:	43235-1342
Country	:	US
Telephone Number	:	614-578-0718
Fax Number	:

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

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	08/31/2012

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