MEDICARE: MS. JULIE ANN WILLSTATTER 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	P062007	NY

General Provider Information

NPI Number	:	1164509428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE ANN WILLSTATTER LCSW

Provider Business Mailing Address
First Line	:	1702 HALF MOON BAY DR
Second Line	:
City	:	CROTON ON HUDSON
State	:	NY
Zip	:	10520-3121
Country	:	US
Telephone Number	:	914-649-3623
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 HALF MOON BAY DR
Second Line	:
City	:	CROTON ON HUDSON
State	:	NY
Zip	:	10520-3121
Country	:	US
Telephone Number	:	914-649-3623
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/03/2020

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