MEDICARE: JULIE BILSE PSYCHOTHERAPY, LLC

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

General Provider Information

NPI Number	:	1457975591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE BILSE PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	66 S FULLERTON AVE APT 13
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2673
Country	:	US
Telephone Number	:	973-821-7843
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 UPPER MONTCLAIR PLZ STE 17
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1340
Country	:	US
Telephone Number	:	973-821-7843
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JULIE BILSE
Credential	:	LCSW
Telephone Number	:	973-821-7843

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	06/04/2020

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