Provider Demographics
NPI:1780015578
Name:VISHNEPOLSKY, JULIA (MA, R-DMT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:VISHNEPOLSKY
Suffix:
Gender:F
Credentials:MA, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MASON ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2265
Mailing Address - Country:US
Mailing Address - Phone:978-745-2440
Mailing Address - Fax:
Practice Address - Street 1:41 MASON ST UNIT 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2265
Practice Address - Country:US
Practice Address - Phone:978-745-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center