Healthcare Provider Details

I. General information

NPI: 1619551132
Provider Name (Legal Business Name): CASSANDRA JULIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 FIREHOUSE RD
PORT ST JOE FL
32456-5776
US

IV. Provider business mailing address

313 FIREHOUSE RD
PORT ST JOE FL
32456-5776
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-2877
  • Fax:
Mailing address:
  • Phone: 850-387-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09931219
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: