Provider Demographics
NPI:1033716204
Name:DEMERY, JULIANNE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:A
Last Name:DEMERY
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:NAVAL BASE SAN DIEGO 2450 CRAVEN STREET #3300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-0001
Mailing Address - Country:US
Mailing Address - Phone:619-631-8595
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BASE SAN DIEGO 2450 CRAVEN STREET #3300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-0001
Practice Address - Country:US
Practice Address - Phone:619-631-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAPY61219498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program