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NPI Code Detail

MEDICARE: JULIE MARIE GREENWELL M.A

MEDICARE: JULIE MARIE GREENWELL M.A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist0115KY

General Provider Information

NPI Number : 1063813491
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE MARIE GREENWELL M.A
Provider Business Mailing Address
First Line : 2823 FRANKFORT AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-2639
Country : US
Telephone Number : 502-893-0241
Fax Number : 502-212-1293
Provider Business Practice Location Address
First Line : 2823 FRANKFORT AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-2639
Country : US
Telephone Number : 502-893-0241
Fax Number : 502-212-1293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2014
Last Update Date : 09/04/2014

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