Provider Demographics
NPI:1770007619
Name:LIGHT, JULIANNE MARY QUIMBY
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:MARY QUIMBY
Last Name:LIGHT
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 1:22 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:TILLSON
Mailing Address - State:NY
Mailing Address - Zip Code:12486-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 MORNING STAR DR
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2932
Practice Address - Country:US
Practice Address - Phone:732-604-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst