Basic Information
| Provider Information | |||||||||
| NPI: | 1467129841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ULLOA | ||||||||
| FirstName: | JOANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 HORIZON DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313962327 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 HORIZON DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313962300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2021 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P110869 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.