Provider Demographics
NPI:1871698928
Name:EBERHARDT, JULIENNE JAE (LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:JULIENNE
Middle Name:JAE
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18245 WILDEMERE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2730
Mailing Address - Country:US
Mailing Address - Phone:313-729-3783
Mailing Address - Fax:313-862-0127
Practice Address - Street 1:18245 WILDEMERE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2730
Practice Address - Country:US
Practice Address - Phone:313-729-3783
Practice Address - Fax:313-862-0127
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL8000061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical