Provider Demographics
NPI:1003093360
Name:INGOLDSBY, JUDY LEE (MA)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LEE
Last Name:INGOLDSBY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4812
Mailing Address - Country:US
Mailing Address - Phone:626-441-2868
Mailing Address - Fax:626-441-6389
Practice Address - Street 1:1910 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4812
Practice Address - Country:US
Practice Address - Phone:626-441-2868
Practice Address - Fax:626-441-6389
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24964106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003093360OtherAETNA
CA1003093360OtherCIGNA BEHAVIORAL HEALTH
CA1003093360OtherBLUE SHIELD
CA1003093360OtherUNITED BEHAVIORAL HEALTH
CA1003093360OtherANTHEM BLUE CROSS
CO1003093360OtherUNITED HEALTH CARE
CA1003093360OtherMANAGED HEALTH NETWORK
CA1003093360OtherHEALTH NET
CA1003093360OtherPACIFICARE