Healthcare Provider Details

I. General information

NPI: 1710437553
Provider Name (Legal Business Name): JULIE LEMELIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BEACH ST
WESTERLY RI
02891-2718
US

IV. Provider business mailing address

11 STONYBROOK RD
GALES FERRY CT
06335-1044
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-6909
  • Fax:
Mailing address:
  • Phone: 860-373-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number221402
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW1908
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003014
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: