Provider Demographics
NPI:1871613059
Name:OSTROPOLSKY, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:OSTROPOLSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 MACKLIND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1400
Mailing Address - Country:US
Mailing Address - Phone:314-645-7800
Mailing Address - Fax:314-645-7802
Practice Address - Street 1:1329 MACKLIND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1400
Practice Address - Country:US
Practice Address - Phone:314-645-7800
Practice Address - Fax:314-645-7802
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001494851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO858806706Medicaid
MO758806707Medicaid
MO498806702Medicaid
MO700603OtherCOUNSELING
MO700603OtherCOUNSELING
MODC1095Medicare ID - Type UnspecifiedCOUNSELING