MEDICARE: JULIETTE ROSE SQUICCIARINI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1073355236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIETTE ROSE SQUICCIARINI

Provider Business Mailing Address
First Line	:	1000 PENINSULA BLVD
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 PENINSULA BLVD
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1542
Country	:	US
Telephone Number	:	516-506-1547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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