Provider Demographics
NPI:1528151073
Name:HUMBERT, JULIE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:HUMBERT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-2336
Mailing Address - Country:US
Mailing Address - Phone:952-221-6576
Mailing Address - Fax:763-479-6060
Practice Address - Street 1:6840 D'CHENE LANE
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55359
Practice Address - Country:US
Practice Address - Phone:952-221-6576
Practice Address - Fax:763-479-6060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN154651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN565G6HUOtherBLUE CROSS BLUE SHIELD