Provider Demographics
NPI:1184829657
Name:ANDERSON, JUDITH ZUCKER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ZUCKER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15615 ALTON PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3341
Mailing Address - Country:US
Mailing Address - Phone:949-727-4337
Mailing Address - Fax:949-494-0865
Practice Address - Street 1:15615 ALTON PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3341
Practice Address - Country:US
Practice Address - Phone:949-727-4337
Practice Address - Fax:949-494-0865
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9636103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist