Provider Demographics
NPI:1508463795
Name:FUBUNIWI, JULIANA FUNKUIN FUNKUIN
Entity type:Individual
Prefix:
First Name:JULIANA FUNKUIN
Middle Name:FUNKUIN
Last Name:FUBUNIWI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:FUNKUIN
Other - Last Name:FUBUNIWI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 TOWBIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5928
Mailing Address - Country:US
Mailing Address - Phone:848-216-5355
Mailing Address - Fax:
Practice Address - Street 1:7901 BROOKFORD CIR APT B
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2601
Practice Address - Country:US
Practice Address - Phone:443-554-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA1894103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst