Provider Demographics
NPI:1093020612
Name:GUARASCIO, JULIE (PSYD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GUARASCIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HAIG AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4507
Mailing Address - Country:US
Mailing Address - Phone:631-219-5781
Mailing Address - Fax:631-569-5419
Practice Address - Street 1:15 HAIG AVE
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4507
Practice Address - Country:US
Practice Address - Phone:631-219-5781
Practice Address - Fax:631-569-5419
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017183-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist