Provider Demographics
NPI:1730463746
Name:CONSOLI, JULIANA MARIA (LMHC)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:MARIA
Last Name:CONSOLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LAMBERT AVE
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1811
Mailing Address - Country:US
Mailing Address - Phone:716-672-8733
Mailing Address - Fax:716-672-8733
Practice Address - Street 1:55 LAMBERT AVE
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1811
Practice Address - Country:US
Practice Address - Phone:716-672-8733
Practice Address - Fax:716-672-8733
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003021-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6190242OtherINDEPENDENT HEALTH