MEDICARE: MRS. JULIE S. EVELEIGH LCSW

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	R041493-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103476FK	OTHER	NY	PREFERRED CARE
2	PO10041493	OTHER	NY	EXCELLUS PROVIDER NUMBER

General Provider Information

NPI Number	:	1932286697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE S. EVELEIGH LCSW

Provider Business Mailing Address
First Line	:	8972 BAKER RD
Second Line	:
City	:	BLOOMFIELD
State	:	NY
Zip	:	14469-9523
Country	:	US
Telephone Number	:	585-624-5380
Fax Number	:

Provider Business Practice Location Address
First Line	:	8972 BAKER RD
Second Line	:
City	:	BLOOMFIELD
State	:	NY
Zip	:	14469-9523
Country	:	US
Telephone Number	:	585-624-5380
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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