MEDICARE: JULIA ANNE GALAUDET PSYD, LCSW

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
1	1041C0700X	Clinical Social Worker	LCS19877	CA

General Provider Information

NPI Number	:	1124528476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA ANNE GALAUDET PSYD, LCSW

Provider Business Mailing Address
First Line	:	8240 BEVERLY BLVD STE 8
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-4529
Country	:	US
Telephone Number	:	310-927-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	8240 BEVERLY BLVD STE 8
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-4529
Country	:	US
Telephone Number	:	310-927-6816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	06/16/2018

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