Provider Demographics
NPI:1003069352
Name:MAXWALD-SHREY, JULIANE (MA, LP, CASAC)
Entity Type:Individual
Prefix:
First Name:JULIANE
Middle Name:
Last Name:MAXWALD-SHREY
Suffix:
Gender:F
Credentials:MA, LP, CASAC
Other - Prefix:
Other - First Name:JULIANE
Other - Middle Name:
Other - Last Name:MAXWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 50TH AVE APT 2804
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-6093
Mailing Address - Country:US
Mailing Address - Phone:929-919-1519
Mailing Address - Fax:
Practice Address - Street 1:531 50TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5711
Practice Address - Country:US
Practice Address - Phone:929-919-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000920102L00000X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst