Provider Demographics
NPI:1710401153
Name:FOTINO, JULIANA
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:FOTINO
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 1:1003 7TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5779
Mailing Address - Country:US
Mailing Address - Phone:142-565-8301
Mailing Address - Fax:425-658-3017
Practice Address - Street 1:1003 7TH AVE STE A
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5779
Practice Address - Country:US
Practice Address - Phone:142-565-8301
Practice Address - Fax:425-658-3017
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61088344103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst