Provider Demographics
NPI:1609683903
Name:BRUCATO, JULIA (SLP-CF / TSSLD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BRUCATO
Suffix:
Gender:F
Credentials:SLP-CF / TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HALLISTER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2724
Mailing Address - Country:US
Mailing Address - Phone:347-838-0331
Mailing Address - Fax:
Practice Address - Street 1:622 THIRD AVENUE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-634-2803
Practice Address - Fax:646-650-5963
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1862369241390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program