1184753493 NPI number — MS. JULIA HERSKOWITZ LIC.AC.

Table of content: MS. JULIA HERSKOWITZ LIC.AC. (NPI 1184753493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184753493 NPI number — MS. JULIA HERSKOWITZ LIC.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERSKOWITZ
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LIC.AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184753493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 BRADFORD TER
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02446-6000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-566-2383
Provider Business Mailing Address Fax Number:
617-383-5787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 WASHINGTON ST
Provider Second Line Business Practice Location Address:
PATHWAYS TO WELLNESS - 3RD FLOOR
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02118-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-859-3036
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  497 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)