Healthcare Provider Details

I. General information

NPI: 1205110863
Provider Name (Legal Business Name): JULIE MAIMARON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MERRIMACK ST
HAVERHILL MA
01830-6207
US

IV. Provider business mailing address

60 MERRIMACK ST
HAVERHILL MA
01830-6207
US

V. Phone/Fax

Practice location:
  • Phone: 978-521-7777
  • Fax: 978-521-7767
Mailing address:
  • Phone: 978-521-7777
  • Fax: 978-521-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: