Provider Demographics
NPI:1326543620
Name:BREVIARIO, JULIANNA ELIZABETH
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:ELIZABETH
Last Name:BREVIARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9955 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3949
Mailing Address - Country:US
Mailing Address - Phone:646-206-8578
Mailing Address - Fax:
Practice Address - Street 1:1470 39TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3618
Practice Address - Country:US
Practice Address - Phone:718-854-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019379-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty