Provider Demographics
NPI:1962793448
Name:GARDELLA-FORTIER, JULIA MYRIAH
Entity type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:MYRIAH
Last Name:GARDELLA-FORTIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E 7TH ST
Mailing Address - Street 2:APT 416
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5975
Mailing Address - Country:US
Mailing Address - Phone:617-519-9685
Mailing Address - Fax:
Practice Address - Street 1:190 E 7TH ST
Practice Address - Street 2:APT 416
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-5975
Practice Address - Country:US
Practice Address - Phone:617-519-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst