Provider Demographics
NPI:1588088074
Name:VAN NOSTRAND, JULIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:VAN NOSTRAND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 KETTLE HOLE RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2857
Mailing Address - Country:US
Mailing Address - Phone:631-926-0803
Mailing Address - Fax:
Practice Address - Street 1:21 KETTLE HOLE RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2857
Practice Address - Country:US
Practice Address - Phone:631-926-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00787-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist