Healthcare Provider Details

I. General information

NPI: 1700429081
Provider Name (Legal Business Name): JULIANA NICOLE HUDSON ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2019
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 540
SANTA MONICA CA
90404-2118
US

IV. Provider business mailing address

470 E 3RD ST STE C
LOS ANGELES CA
90013-1630
US

V. Phone/Fax

Practice location:
  • Phone: 310-582-7612
  • Fax:
Mailing address:
  • Phone: 213-620-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number143269
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: