Provider Demographics
NPI:1215088943
Name:COLANTONIO, JULIE (LCSW, LCDC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:COLANTONIO
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MARRELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3801 KIRBY DR
Mailing Address - Street 2:SUITE 730
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4100
Mailing Address - Country:US
Mailing Address - Phone:713-533-1560
Mailing Address - Fax:713-533-1656
Practice Address - Street 1:3801 KIRBY DR
Practice Address - Street 2:SUITE 730
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4100
Practice Address - Country:US
Practice Address - Phone:713-533-1560
Practice Address - Fax:713-533-1656
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168251041C0700X
TX4470101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0S61PMedicare ID - Type UnspecifiedINACTIVE