Provider Demographics
NPI:1437816311
Name:KOUASSI, JULIANA I (NO)
Entity Type:Individual
Prefix:MISS
First Name:JULIANA
Middle Name:
Last Name:KOUASSI
Suffix:I
Gender:F
Credentials:NO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BITTERSWEET BLVD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-4500
Mailing Address - Country:US
Mailing Address - Phone:508-414-6683
Mailing Address - Fax:
Practice Address - Street 1:48 SWORD ST STE 208
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2162
Practice Address - Country:US
Practice Address - Phone:508-368-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical