Provider Demographics
NPI:1063792497
Name:PICKETT, JULIA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:M
Last Name:PICKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3210 EAST 10TH STREET #6483
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408
Mailing Address - Country:US
Mailing Address - Phone:502-501-3646
Mailing Address - Fax:502-780-5933
Practice Address - Street 1:3210 E 10TH ST # 6483
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-2753
Practice Address - Country:US
Practice Address - Phone:502-501-3646
Practice Address - Fax:502-780-5933
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2558871041C0700X
374J00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist