Basic Information
Provider Information | |||||||||
NPI: | 1184085334 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DOSTIE | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 30 | ||||||||
Address2: |   | ||||||||
City: | GREAT BARRINGTON | ||||||||
State: | MA | ||||||||
PostalCode: | 01230 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135289311 | ||||||||
FaxNumber: | 4136440274 | ||||||||
Practice Location | |||||||||
Address1: | 510 NORTH STREET | ||||||||
Address2: | SUITE 1 | ||||||||
City: | PITTSFIELD | ||||||||
State: | MA | ||||||||
PostalCode: | 01201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4134472351 | ||||||||
FaxNumber: | 4134457009 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/16/2016 | ||||||||
LastUpdateDate: | 02/27/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 118338 | MA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | 110118777A | 05 | MA |   | MEDICAID |