Provider Demographics
NPI:1124660253
Name:BOT SALAU, JULIANA (LICSW)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:BOT SALAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6572 ELDERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6485
Mailing Address - Country:US
Mailing Address - Phone:301-437-0485
Mailing Address - Fax:
Practice Address - Street 1:2526 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6719
Practice Address - Country:US
Practice Address - Phone:202-748-5641
Practice Address - Fax:202-748-5647
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166021041C0700X
DCLC500799751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical