Provider Demographics
NPI:1205495785
Name:ORICCHIO, JULIA STARK (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:STARK
Last Name:ORICCHIO
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:BRENNA MCCHESNEY
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVENUE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:
Practice Address - Street 1:400 COLUMBUS AVE
Practice Address - Street 2:APC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3075
Practice Address - Fax:203-503-3296
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8265363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008089564Medicaid