Provider Demographics
NPI:1932928355
Name:JULIE MODAVIS LCSW PLLC
Entity type:Organization
Organization Name:JULIE MODAVIS LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MODAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-707-4929
Mailing Address - Street 1:4307 TOWNEHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2855
Mailing Address - Country:US
Mailing Address - Phone:631-707-4929
Mailing Address - Fax:
Practice Address - Street 1:4307 TOWNEHOUSE DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2855
Practice Address - Country:US
Practice Address - Phone:631-707-4929
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?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty