MEDICARE: JULIE EARLE LLCSW

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	6851120550	MI

General Provider Information

NPI Number	:	1780547562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE EARLE LLCSW

Provider Business Mailing Address
First Line	:	1688 DEWEY AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-1818
Country	:	US
Telephone Number	:	313-205-1617
Fax Number	:

Provider Business Practice Location Address
First Line	:	3133 LAKESHORE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2647
Country	:	US
Telephone Number	:	269-588-3167
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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