Provider Demographics
NPI:1114471919
Name:MATHIEU, JUDITH (LMHC, NCC, BCCMLC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:LMHC, NCC, BCCMLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 SNYDER AVE
Mailing Address - Street 2:APT. D1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5100
Mailing Address - Country:US
Mailing Address - Phone:646-262-2046
Mailing Address - Fax:
Practice Address - Street 1:179 E 116TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1459
Practice Address - Country:US
Practice Address - Phone:212-222-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health