Basic Information
Provider Information | |||||||||
NPI: | 1346599750 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TEITELBAUM | ||||||||
FirstName: | JULIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW, LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ARONOW-FRIEDEN | ||||||||
OtherFirstName: | JULIA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 55 ABBEY LN | ||||||||
Address2: | UNIT 5310 | ||||||||
City: | DANBURY | ||||||||
State: | CT | ||||||||
PostalCode: | 068105224 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4802299223 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 731 MAIN ST | ||||||||
Address2: |   | ||||||||
City: | MONROE | ||||||||
State: | CT | ||||||||
PostalCode: | 064682872 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2032617090 | ||||||||
FaxNumber: | 8888563413 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2012 | ||||||||
LastUpdateDate: | 07/24/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/24/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2014029523 | MO | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SC 60167118 | WA | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 009636 | CT | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | CO 60195232 | WA | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.