Healthcare Provider Details

I. General information

NPI: 1952069452
Provider Name (Legal Business Name): JULIE FRIEND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 THE ALAMEDA STE 106
BERKELEY CA
94707-2311
US

IV. Provider business mailing address

1461 PORTLAND AVE
BERKELEY CA
94706-1451
US

V. Phone/Fax

Practice location:
  • Phone: 510-527-9750
  • Fax:
Mailing address:
  • Phone: 510-527-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLR012276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: