MEDICARE: JULIA B WALTMAN LCPC-C

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	101YP2500X	Professional Counselor	XL4602	ME

General Provider Information

NPI Number	:	1447790498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA B WALTMAN LCPC-C

Provider Business Mailing Address
First Line	:	29 DAY RD
Second Line	:
City	:	DURHAM
State	:	ME
Zip	:	04222-5407
Country	:	US
Telephone Number	:	207-712-7576
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 PARK ROW STE 8
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2039
Country	:	US
Telephone Number	:	207-712-7576
Fax Number	:

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

Provider Enumeration Date	:	02/24/2017
Last Update Date	:	11/13/2018

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