Healthcare Provider Details

I. General information

NPI: 1790006872
Provider Name (Legal Business Name): JULIA YACOOB PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2010
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MERCER ST SUITE 3C
NEW YORK NY
10003-6724
US

IV. Provider business mailing address

300 MERCER ST SUITE 3C
NEW YORK NY
10003-6724
US

V. Phone/Fax

Practice location:
  • Phone: 917-740-5363
  • Fax:
Mailing address:
  • Phone: 917-740-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: