Provider Demographics
NPI:1114026135
Name:JULIANO, MARY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:JULIANO
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 1:8 BARSTOW RD
Mailing Address - Street 2:1C
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-487-1448
Mailing Address - Fax:516-773-3871
Practice Address - Street 1:8 BARSTOW RD
Practice Address - Street 2:1C
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-487-1448
Practice Address - Fax:516-773-3871
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00565480Medicaid
NYV15761Medicare ID - Type Unspecified