Healthcare Provider Details

I. General information

NPI: 1093665952
Provider Name (Legal Business Name): JULIANA FODERA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHURCH ST FL 8
NEW YORK NY
10007-2614
US

IV. Provider business mailing address

700 MASSACHUSETTS AVE FL 3
CAMBRIDGE MA
02139-3345
US

V. Phone/Fax

Practice location:
  • Phone: 888-500-2067
  • Fax: 617-649-8520
Mailing address:
  • Phone: 888-500-2067
  • Fax: 617-649-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121414-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: