Healthcare Provider Details

I. General information

NPI: 1053783019
Provider Name (Legal Business Name): JULIE HERZLINGER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 N MAIN ST
PROVIDENCE RI
02904-5715
US

IV. Provider business mailing address

959 N MAIN ST
PROVIDENCE RI
02904-5715
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-1244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01225
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: