=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578068938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE ALLISON WASHBURN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2018
-----------------------------------------------------
Last Update Date | 03/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 93 WINCHESTER ST
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02446-2755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-730-2760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 MAPLE ST APT 1
-----------------------------------------------------
City | WEST ROXBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02132-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-327-4461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 110194
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------