Provider Demographics
NPI:1598130981
Name:JULISSA LA TERAPISTA, LLC
Entity Type:Organization
Organization Name:JULISSA LA TERAPISTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:ABD, MSW, MED
Authorized Official - Phone:302-505-5577
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-0101
Mailing Address - Country:US
Mailing Address - Phone:302-505-5577
Mailing Address - Fax:
Practice Address - Street 1:406 DELAWARE STREET
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720
Practice Address - Country:US
Practice Address - Phone:302-505-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health