Provider Demographics
NPI:1720807142
Name:WALNUT AVENUE FAMILY & WOMEN'S CENTER
Entity type:Organization
Organization Name:WALNUT AVENUE FAMILY & WOMEN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACECEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:PSY23881
Authorized Official - Phone:831-426-3062
Mailing Address - Street 1:303 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3659
Mailing Address - Country:US
Mailing Address - Phone:831-426-3062
Mailing Address - Fax:
Practice Address - Street 1:303 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3659
Practice Address - Country:US
Practice Address - Phone:831-426-3062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable