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NPI Code Detail

MEDICARE: JULIE PACKARD LCSW, RN

MEDICARE:   JULIE  PACKARD  LCSW, RN
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
11041C0700XClinical Social Worker071061NY

General Provider Information

NPI Number : 1326153099
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE PACKARD LCSW, RN
Provider Business Mailing Address
First Line : PO BOX 10787
Second Line :
City : ROCHESTER
State : NY
Zip : 14610-0787
Country : US
Telephone Number : 585-922-1122
Fax Number : 585-922-1985
Provider Business Practice Location Address
First Line : 490 RIDGE RD E
Second Line :
City : ROCHESTER
State : NY
Zip : 14621-1229
Country : US
Telephone Number : 585-922-2500
Fax Number : 585-922-2664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 07/08/2007

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