Provider Demographics
NPI:1073815429
Name:BERMUDEZ, JUDITH MARIA (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIA
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1704
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30603-1704
Mailing Address - Country:US
Mailing Address - Phone:706-369-7911
Mailing Address - Fax:706-208-9509
Practice Address - Street 1:455 N LUMPKIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2744
Practice Address - Country:US
Practice Address - Phone:706-369-7911
Practice Address - Fax:706-208-9509
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist