Provider Demographics
NPI:1093046872
Name:JULIANO, STEFANIE (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:JULIANO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 SOUTHERN BLVD SE
Mailing Address - Street 2:#14
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3797
Mailing Address - Country:US
Mailing Address - Phone:505-994-0161
Mailing Address - Fax:
Practice Address - Street 1:4111 BARBARA LOOP SE STE E1
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1068
Practice Address - Country:US
Practice Address - Phone:505-715-9587
Practice Address - Fax:505-672-7769
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36120324Medicaid