Healthcare Provider Details

I. General information

NPI: 1104136506
Provider Name (Legal Business Name): JULIE AXELROD AUSTIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MILLER AVE STE G
MILL VALLEY CA
94941-2858
US

IV. Provider business mailing address

240 MILLER AVE STE G
MILL VALLEY CA
94941-2858
US

V. Phone/Fax

Practice location:
  • Phone: 415-928-7800
  • Fax:
Mailing address:
  • Phone: 415-272-4515
  • Fax: 415-381-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: