Provider Demographics
NPI:1427473016
Name:JULIA FISCHETTO, MS,PA
Entity type:Organization
Organization Name:JULIA FISCHETTO, MS,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIA FISCHETTO
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:FISCHETTO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-491-9040
Mailing Address - Street 1:5208 NE 24TH TER APT 317F
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3947
Mailing Address - Country:US
Mailing Address - Phone:954-491-9040
Mailing Address - Fax:954-492-0334
Practice Address - Street 1:218 COMMERCIAL BLVD STE 201H
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-4455
Practice Address - Country:US
Practice Address - Phone:954-491-9040
Practice Address - Fax:954-492-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 0003922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID