Provider Demographics
NPI:1003214669
Name:FOSTER, JUDITH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 TRAILS END CIR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3588
Mailing Address - Country:US
Mailing Address - Phone:609-475-5079
Mailing Address - Fax:
Practice Address - Street 1:618 TRAILS END CIR
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3588
Practice Address - Country:US
Practice Address - Phone:609-475-5079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical