MEDICARE: JULIA KENDALL DONNELLY 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	SW26476	FL

General Provider Information

NPI Number	:	1851169858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA KENDALL DONNELLY LCSW

Provider Business Mailing Address
First Line	:	3855 PENNSYLVANIA AVE
Second Line	:
City	:	MIMS
State	:	FL
Zip	:	32754-4778
Country	:	US
Telephone Number	:	321-514-3288
Fax Number	:

Provider Business Practice Location Address
First Line	:	3910 S WASHINGTON AVE STE 207
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-5800
Country	:	US
Telephone Number	:	407-917-6828
Fax Number	:

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

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	05/28/2026

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