Healthcare Provider Details

I. General information

NPI: 1770615643
Provider Name (Legal Business Name): JULIANNE HENRY L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIR
GRASS VALLEY CA
95945-9561
US

IV. Provider business mailing address

15629 MOUNT OLIVE RD
GRASS VALLEY CA
95945-7997
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-1437
  • Fax:
Mailing address:
  • Phone: 530-346-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: