=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063560498
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH JULIANA MSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 LAKE AVE
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-978-7349
-----------------------------------------------------
Fax | 631-667-1708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 PHILIP LANE
-----------------------------------------------------
City | MIDDLE ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11953-2689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-914-1870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | PRO134931
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------