Provider Demographics
NPI:1215119714
Name:JULIAN, NANCY STORM (LISW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:STORM
Last Name:JULIAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LOMA COLORADO ST NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6562
Mailing Address - Country:US
Mailing Address - Phone:505-896-5955
Mailing Address - Fax:505-896-5911
Practice Address - Street 1:301 LOMA COLORADO ST NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6562
Practice Address - Country:US
Practice Address - Phone:505-896-5955
Practice Address - Fax:505-896-5911
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2613861041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28941Medicaid