Provider Demographics
NPI:1992899520
Name:JULIANO, BETH MICHELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:MICHELLE
Last Name:JULIANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:MICHELLE
Other - Last Name:GAROFALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 CAMBRIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1900
Mailing Address - Country:US
Mailing Address - Phone:860-632-1761
Mailing Address - Fax:
Practice Address - Street 1:784 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1619
Practice Address - Country:US
Practice Address - Phone:860-523-4450
Practice Address - Fax:860-523-9537
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140006157CT01OtherANTHEM