Provider Demographics
NPI:1629956123
Name:ST JEAN, JULIA (LMSW)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:ST JEAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06232-1515
Mailing Address - Country:US
Mailing Address - Phone:860-207-0212
Mailing Address - Fax:860-207-0212
Practice Address - Street 1:37 CAMP MOWEEN RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:CT
Practice Address - Zip Code:06249-2704
Practice Address - Country:US
Practice Address - Phone:860-294-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT114681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical