Provider Demographics
NPI:1033466388
Name:JUDITH LUNDQUIST LCSW PLLC
Entity Type:Organization
Organization Name:JUDITH LUNDQUIST LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-451-5126
Mailing Address - Street 1:572 TITUS AVE
Mailing Address - Street 2:STE B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3519
Mailing Address - Country:US
Mailing Address - Phone:585-451-5126
Mailing Address - Fax:585-266-9336
Practice Address - Street 1:572 TITUS AVE
Practice Address - Street 2:STE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3519
Practice Address - Country:US
Practice Address - Phone:585-451-5126
Practice Address - Fax:585-266-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02126011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty