Provider Demographics
NPI:1568762177
Name:GAST, JULIANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:
Last Name:GAST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 DANA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1025
Mailing Address - Country:US
Mailing Address - Phone:513-321-6644
Mailing Address - Fax:
Practice Address - Street 1:1117 FEHL LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4349
Practice Address - Country:US
Practice Address - Phone:513-321-6644
Practice Address - Fax:513-956-2858
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical