Provider Demographics
NPI:1104136506
Name:AUSTIN, JULIE AXELROD (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:AXELROD
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MILLER AVE STE G
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2858
Mailing Address - Country:US
Mailing Address - Phone:415-272-4515
Mailing Address - Fax:415-381-6236
Practice Address - Street 1:240 MILLER AVE STE G
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2858
Practice Address - Country:US
Practice Address - Phone:415-928-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical