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General NPI Number Information
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NPI Number | 1497083919
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Entity Type | Individual
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Provider Name | JERRA LYNN JULIANO LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 21 W 2ND ST STE 5
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City | RIVERHEAD
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State | NY
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Zip | 11901-2752
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Country | US
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Telephone | 516-426-2700
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Fax | 631-337-6969
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Provider Business Mailing Address
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Address Line | 14 PECONIC LN
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City | SELDEN
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State | NY
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Zip | 11784-2846
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Country | US
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Telephone | 516-426-2700
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Fax | 631-337-6969
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0829261
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License Number State | NY
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