Provider Demographics
NPI:1427711548
Name:WORTHEN, JULIE A (BCBA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:WORTHEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 BEACON ST STE 18
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3793
Mailing Address - Country:US
Mailing Address - Phone:844-222-4513
Mailing Address - Fax:
Practice Address - Street 1:1318 BEACON ST STE 18
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3793
Practice Address - Country:US
Practice Address - Phone:844-222-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-49961103K00000X
MALABA3769103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst