Provider Demographics
NPI:1770204794
Name:SHIELDS, JULIENNE MARIE
Entity type:Individual
Prefix:
First Name:JULIENNE
Middle Name:MARIE
Last Name:SHIELDS
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 1:181 W MIDLAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1867
Mailing Address - Country:US
Mailing Address - Phone:201-248-6702
Mailing Address - Fax:
Practice Address - Street 1:181 W MIDLAND AVE APT 2
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1867
Practice Address - Country:US
Practice Address - Phone:201-248-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06835700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker