Provider Demographics
NPI:1144371394
Name:TILLEY, JULIA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:L
Last Name:TILLEY
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 1:2016 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-2127
Mailing Address - Country:US
Mailing Address - Phone:717-503-9933
Mailing Address - Fax:717-754-0017
Practice Address - Street 1:312 S PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5722
Practice Address - Country:US
Practice Address - Phone:717-540-9505
Practice Address - Fax:717-540-9527
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1862950Medicaid