MEDICARE: MRS. IULIIA GULAKOVA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavioral Analyst

General Provider Information

NPI Number	:	1467092684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IULIIA GULAKOVA BCBA

Provider Business Mailing Address
First Line	:	86 ALEXANDER AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1910
Country	:	US
Telephone Number	:	347-339-6726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2069 85TH ST APT 5H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3227
Country	:	US
Telephone Number	:	347-339-6726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	10/12/2022

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