Provider Demographics
NPI:1174773436
Name:JULIANO, MIMI LAURA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:LAURA
Last Name:JULIANO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 MAIN ST
Mailing Address - Street 2:SUITE 1 D
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3570
Mailing Address - Country:US
Mailing Address - Phone:516-420-1780
Mailing Address - Fax:516-420-1780
Practice Address - Street 1:475 MAIN ST
Practice Address - Street 2:SUITE 1 D
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3570
Practice Address - Country:US
Practice Address - Phone:516-420-1780
Practice Address - Fax:516-420-1780
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010776-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist