MEDICARE: JULIE VINKLE 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	083380	NY

General Provider Information

NPI Number	:	1194304808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE VINKLE LCSW

Provider Business Mailing Address
First Line	:	149 COUNTRYSIDE LN
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-2517
Country	:	US
Telephone Number	:	716-400-1177
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 COUNTRYSIDE LN
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-2517
Country	:	US
Telephone Number	:	716-400-1177
Fax Number	:

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

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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