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General NPI Number Information
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NPI Number | 1235548959
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Entity Type | Individual
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Provider Name | JULIE DEANE LMT; CLT
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Gender | Female
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 97 NEW DORP LN
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2364
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Country | US
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Telephone | 718-980-5161
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Fax |
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Provider Business Mailing Address
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Address Line | 30 LAWRENCE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-3028
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Country | US
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Telephone | 917-841-0039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 027381-1
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License Number State | NY
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