Provider Demographics
NPI:1366899577
Name:BADARACCO, JULIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:BADARACCO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 FRAZEE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4350
Mailing Address - Country:US
Mailing Address - Phone:619-929-0863
Mailing Address - Fax:
Practice Address - Street 1:1455 FRAZEE RD STE 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4350
Practice Address - Country:US
Practice Address - Phone:619-929-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical