Provider Demographics
NPI:1194861542
Name:ALBERT, JUDITH C
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:C
Last Name:ALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:SMITH
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1152 DAVIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-8842
Mailing Address - Country:US
Mailing Address - Phone:707-462-7843
Mailing Address - Fax:
Practice Address - Street 1:406 W STANDLEY
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-8842
Practice Address - Country:US
Practice Address - Phone:707-463-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC28237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist