Healthcare Provider Details

I. General information

NPI: 1619916319
Provider Name (Legal Business Name): JULIA M SANTACROCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE
BATH NY
14810-0810
US

IV. Provider business mailing address

324 E WILLIAM ST
BATH NY
14810-1637
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4528
  • Fax:
Mailing address:
  • Phone: 607-776-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0700121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: