Provider Demographics
NPI:1083780092
Name:TSUKROFF, JUDITH P (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:P
Last Name:TSUKROFF
Suffix:
Gender:F
Credentials: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 483
Mailing Address - Street 2:58 GREENWOODS RD W
Mailing Address - City:NORFOLK
Mailing Address - State:CT
Mailing Address - Zip Code:06058-0483
Mailing Address - Country:US
Mailing Address - Phone:860-542-5786
Mailing Address - Fax:860-542-5786
Practice Address - Street 1:58 GREENWOODS RD W
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:CT
Practice Address - Zip Code:06058-0483
Practice Address - Country:US
Practice Address - Phone:860-542-5786
Practice Address - Fax:860-542-5786
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist