Provider Demographics
NPI:1699496208
Name:DIVAKARAN, JULIA FISHER (PSYD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:FISHER
Last Name:DIVAKARAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:401 S VAN BRUNT ST STE 204A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 S VAN BRUNT ST STE 204A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4600
Practice Address - Country:US
Practice Address - Phone:201-894-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ223-044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical