Provider Demographics
NPI:1306985650
Name:AGAPE, JULIA (MA)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:AGAPE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 HAVEN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91703
Mailing Address - Country:US
Mailing Address - Phone:909-980-6700
Mailing Address - Fax:909-980-6003
Practice Address - Street 1:9500 HAVEN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91703
Practice Address - Country:US
Practice Address - Phone:909-980-6700
Practice Address - Fax:909-980-6003
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical