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General NPI Number Information
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NPI Number | 1447861364
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Entity Type | Individual
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Provider Name | JULIANA LEE WILLEY
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Gender | Female
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 500 VICTORY RD
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City | QUINCY
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State | MA
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Zip | 02171-3139
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Country | US
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Telephone | 627-847-1902
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Fax |
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Provider Business Mailing Address
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Address Line | 1691 COMMONWEALTH AVE APT 8
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City | BRIGHTON
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State | MA
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Zip | 02135-4820
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Country | US
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Telephone | 518-366-8453
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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