Provider Demographics
NPI:1053190843
Name:BRESLAUER, JULIE BROOKE (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:BROOKE
Last Name:BRESLAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 BROADWAY # 2N
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1228
Mailing Address - Country:US
Mailing Address - Phone:516-765-5162
Mailing Address - Fax:
Practice Address - Street 1:1022 BROADWAY # 2N
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1228
Practice Address - Country:US
Practice Address - Phone:516-765-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095280-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical