Provider Demographics
NPI:1790006872
Name:YACOOB, JULIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:YACOOB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MERCER ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6724
Mailing Address - Country:US
Mailing Address - Phone:917-740-5363
Mailing Address - Fax:
Practice Address - Street 1:300 MERCER ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6724
Practice Address - Country:US
Practice Address - Phone:917-740-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist