Provider Demographics
NPI:1174807044
Name:HEWETT, JULIE A (PHD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:HEWETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WILSHIRE BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2335
Mailing Address - Country:US
Mailing Address - Phone:424-354-0525
Mailing Address - Fax:
Practice Address - Street 1:3201 WILSHIRE BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2335
Practice Address - Country:US
Practice Address - Phone:424-354-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27993103TC2200X
CA27993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27993OtherBOARD OF PSYCHOLOGY