Provider Demographics
NPI:1164560785
Name:PANAS, JUDITH D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:D
Last Name:PANAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3000
Mailing Address - Country:US
Mailing Address - Phone:212-431-6259
Mailing Address - Fax:
Practice Address - Street 1:103 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3000
Practice Address - Country:US
Practice Address - Phone:212-431-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-055047-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health