Healthcare Provider Details

I. General information

NPI: 1982090460
Provider Name (Legal Business Name): JULIA PAULSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 SALISBURY RD
BEMUS POINT NY
14712-9747
US

IV. Provider business mailing address

4125 SALISBURY RD
BEMUS POINT NY
14712-9747
US

V. Phone/Fax

Practice location:
  • Phone: 716-272-2208
  • Fax: 716-332-2820
Mailing address:
  • Phone: 716-272-2208
  • Fax: 716-332-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00076663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: