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General NPI Number Information
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NPI Number | 1679389746
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Entity Type | Individual
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Provider Name | JULISSA JEANETTE BARRETO SIERRA CASAC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 6336 99TH ST
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City | REGO PARK
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State | NY
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Zip | 11374-1979
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Country | US
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Telephone | 347-975-2390
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Fax |
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Provider Business Mailing Address
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Address Line | 646 OAKSIDE RD
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598-1931
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Country | US
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Telephone | 914-575-1634
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 36249
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License Number State | NY
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