Provider Demographics
NPI:1396970315
Name:BEATTY, JULIE M (LPT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:BEATTY
Suffix:
Gender:F
Credentials:LPT
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Other - Credentials:
Mailing Address - Street 1:871 ENBORG CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2645
Mailing Address - Country:US
Mailing Address - Phone:408-885-7855
Mailing Address - Fax:408-885-7854
Practice Address - Street 1:871 ENBORG CT
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2645
Practice Address - Country:US
Practice Address - Phone:408-885-7855
Practice Address - Fax:408-885-7854
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT29913167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician