Provider Demographics
NPI:1871174946
Name:BUSSOLARI, JULIA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:BUSSOLARI
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 1:200 MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4119
Mailing Address - Country:US
Mailing Address - Phone:401-728-1800
Mailing Address - Fax:401-633-7119
Practice Address - Street 1:200 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4119
Practice Address - Country:US
Practice Address - Phone:401-728-1800
Practice Address - Fax:401-633-7119
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW024451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical