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General NPI Number Information
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NPI Number | 1548545999
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Entity Type | Individual
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Provider Name | JULIE DIMMITT PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 07/16/2021
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Provider Practice Location Address
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Address Line | 15951 LOS GATOS BLVD STE 14
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City | LOS GATOS
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State | CA
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Zip | 95032-3488
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Country | US
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Telephone | 408-402-8522
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Fax |
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Provider Business Mailing Address
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Address Line | 15951 LOS GATOS BLVD STE 14
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City | LOS GATOS
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State | CA
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Zip | 95032-3488
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8917079-2501
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License Number State | UT
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