Provider Demographics
NPI:1760738819
Name:HARRISON, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:HARRISON
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 1:225 E 149TH ST
Mailing Address - Street 2:9G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5524
Mailing Address - Country:US
Mailing Address - Phone:718-742-9728
Mailing Address - Fax:
Practice Address - Street 1:225 E 149TH ST
Practice Address - Street 2:9G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5524
Practice Address - Country:US
Practice Address - Phone:718-742-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency