Provider Demographics
NPI:1326896275
Name:TITTERINGOTN, JULIA (LMSW)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:TITTERINGOTN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SCHWEGLER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2638
Mailing Address - Country:US
Mailing Address - Phone:716-909-3993
Mailing Address - Fax:
Practice Address - Street 1:42 SCHWEGLER RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2638
Practice Address - Country:US
Practice Address - Phone:716-909-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106369-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker