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General NPI Number Information
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NPI Number | 1083438113
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Entity Type | Individual
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Provider Name | JULIA RAE BERON MSW, LCSW-A
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Gender | Female
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 700 N CANNON BLVD STE 106
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City | KANNAPOLIS
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State | NC
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Zip | 28083-4078
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Country | US
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Telephone | 980-206-3722
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Fax |
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Provider Business Mailing Address
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Address Line | 145 NEW BERN ST APT 144
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City | CHARLOTTE
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State | NC
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Zip | 28209-4301
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Country | US
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Telephone | 973-865-2721
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P020722
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License Number State | NC
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