Provider Demographics
NPI:1497083919
Name:JULIANO, JERRA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JERRA
Middle Name:LYNN
Last Name:JULIANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PECONIC LN
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2846
Mailing Address - Country:US
Mailing Address - Phone:516-426-2700
Mailing Address - Fax:631-337-6969
Practice Address - Street 1:21 W 2ND ST STE 5
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2752
Practice Address - Country:US
Practice Address - Phone:516-426-2700
Practice Address - Fax:631-337-6969
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08292611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical