Provider Demographics
NPI:1376993352
Name:SLARK, JULIANNA
Entity type:Individual
Prefix:MRS
First Name:JULIANNA
Middle Name:
Last Name:SLARK
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 1:841 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235
Mailing Address - Country:US
Mailing Address - Phone:603-934-1464
Mailing Address - Fax:
Practice Address - Street 1:841 CENTRAL ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2053
Practice Address - Country:US
Practice Address - Phone:603-934-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT218414439106H00000X
NH267106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist