Provider Demographics
NPI:1114105806
Name:LISZKA, JULIE M (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:M
Last Name:LISZKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:LISZKA-CHALONER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:6900 SOUTHPOINT DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8007
Mailing Address - Country:US
Mailing Address - Phone:904-470-6900
Mailing Address - Fax:904-739-0171
Practice Address - Street 1:6900 SOUTHPOINT DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8007
Practice Address - Country:US
Practice Address - Phone:904-470-6900
Practice Address - Fax:904-739-0171
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist