Provider Demographics
NPI:1033130844
Name:BUCHOLTZ, JUDITH J (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:J
Last Name:BUCHOLTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6605
Mailing Address - Country:US
Mailing Address - Phone:310-826-1141
Mailing Address - Fax:310-207-2728
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6605
Practice Address - Country:US
Practice Address - Phone:310-826-1141
Practice Address - Fax:310-207-2728
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24827106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist