Provider Demographics
NPI:1164933446
Name:JUDGE, YVONNE (LCSW)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:JUDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:SILVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:424 W KNOWLES AVE APT J
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-2041
Mailing Address - Country:US
Mailing Address - Phone:727-201-6835
Mailing Address - Fax:
Practice Address - Street 1:7025 HARBOUR VIEW BLVD STE 119
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2762
Practice Address - Country:US
Practice Address - Phone:757-758-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA134759104100000X
FLSW209371041C0700X
PACW0214931041C0700X
PACW0214831041C0700X
VA09040151631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker