Provider Demographics
NPI:1477123982
Name:SISLEY, JULIANNE MICHELLE
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:MICHELLE
Last Name:SISLEY
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 1:29 E MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1400
Mailing Address - Country:US
Mailing Address - Phone:508-579-5077
Mailing Address - Fax:
Practice Address - Street 1:29 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1400
Practice Address - Country:US
Practice Address - Phone:508-579-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst