Provider Demographics
NPI:1962171546
Name:JULAINE BEATTY LCSW PLLC
Entity type:Organization
Organization Name:JULAINE BEATTY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-794-2834
Mailing Address - Street 1:2 MOUNTAINVIEW TER UNIT 6203
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4173
Mailing Address - Country:US
Mailing Address - Phone:203-794-2834
Mailing Address - Fax:475-204-3581
Practice Address - Street 1:2 MOUNTAINVIEW TER UNIT 6203
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4173
Practice Address - Country:US
Practice Address - Phone:203-794-2834
Practice Address - Fax:475-204-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7197918Medicaid