Individual
JULIA KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
9597 STATE RD, SUITE 301, TISBURY, MA 02568
(508) 696-5966
Mailing address
PO BOX 4673, VINEYARD HAVEN, MA 02568
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
110579
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P07757
BLUE CROSS
MA
Enumeration date
01/16/2007
Last updated
07/08/2007
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