Healthcare Provider Details

I. General information

NPI: 1306515663
Provider Name (Legal Business Name): JULIA-ELISE CHILDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD STE 160
PASADENA CA
91105-2507
US

IV. Provider business mailing address

PO BOX 2395
PASADENA CA
91102-2395
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-5308
  • Fax:
Mailing address:
  • Phone: 805-798-7732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: