Provider Demographics
NPI:1831873082
Name:DIJKSTRA, JULIANA MARIA
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:MARIA
Last Name:DIJKSTRA
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 1:99 RICHMOND BLVD UNIT 3A
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3657
Mailing Address - Country:US
Mailing Address - Phone:516-306-5713
Mailing Address - Fax:
Practice Address - Street 1:333 PEARSALL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1842
Practice Address - Country:US
Practice Address - Phone:516-213-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002669103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst