Provider Demographics
NPI:1003957317
Name:OWENS-MANLEY, JUDITH (PHD, LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:OWENS-MANLEY
Suffix:
Gender:F
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2983 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:SAUQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:13456-2915
Mailing Address - Country:US
Mailing Address - Phone:315-737-1543
Mailing Address - Fax:315-737-1543
Practice Address - Street 1:2983 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:SAUQUOIT
Practice Address - State:NY
Practice Address - Zip Code:13456-2915
Practice Address - Country:US
Practice Address - Phone:315-737-1543
Practice Address - Fax:315-737-1543
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032163-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical