Provider Demographics
NPI:1992869234
Name:JULIA LYNN HANKERSON
Entity type:Organization
Organization Name:JULIA LYNN HANKERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HANKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-861-2400
Mailing Address - Street 1:534 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270
Mailing Address - Country:US
Mailing Address - Phone:609-861-2400
Mailing Address - Fax:609-861-2440
Practice Address - Street 1:534 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:NJ
Practice Address - Zip Code:08270
Practice Address - Country:US
Practice Address - Phone:609-861-2400
Practice Address - Fax:609-861-2400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JULIA LYNN HANKERSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
44SC01395700104100000X
NJ442CO1397001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
O52182Medicare UPIN