Healthcare Provider Details

I. General information

NPI: 1740013622
Provider Name (Legal Business Name): JULIANA KOKOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 NEWBURY ST FL 5
BOSTON MA
02116-2925
US

IV. Provider business mailing address

71 KILSYTH RD APT 16
BRIGHTON MA
02135-7826
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 917-612-3438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: