Provider Demographics
NPI:1730807421
Name:OCTAVIUS, JULIET (SP ED)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:OCTAVIUS
Suffix:
Gender:F
Credentials:SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 18TH ST APT B2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4705
Mailing Address - Country:US
Mailing Address - Phone:929-253-9081
Mailing Address - Fax:
Practice Address - Street 1:229 E 18TH ST APT B2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4705
Practice Address - Country:US
Practice Address - Phone:929-253-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2697087103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty