Provider Demographics
NPI:1992015275
Name:FOMICHEVA, JULIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:FOMICHEVA
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:P.O.BOX 79157
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02479-0157
Mailing Address - Country:US
Mailing Address - Phone:617-826-0241
Mailing Address - Fax:617-826-0241
Practice Address - Street 1:411 WAVERLEY OAKS RD., #104
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8449
Practice Address - Country:US
Practice Address - Phone:781-330-3092
Practice Address - Fax:781-893-1171
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical