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NPI Code Detail

MEDICARE: JULIE LANDIS LCSW, CCDP-D

MEDICARE: JULIE LANDIS LCSW, CCDP-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
11041C0700XClinical Social WorkerQ1-0001408DE

General Provider Information

NPI Number : 1841668852
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE LANDIS LCSW, CCDP-D
Provider Business Mailing Address
First Line : 6 N RAILROAD AVE
Second Line :
City : GEORGETOWN
State : DE
Zip : 19947-1242
Country : US
Telephone Number : 302-856-9746
Fax Number : 302-856-9766
Provider Business Practice Location Address
First Line : 6 N RAILROAD AVE
Second Line :
City : GEORGETOWN
State : DE
Zip : 19947-1242
Country : US
Telephone Number : 302-856-9746
Fax Number : 302-856-9766
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2015
Last Update Date : 09/08/2015

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