Provider Demographics
NPI:1235284944
Name:NAVARRO, JUDITH MARLENE (MA)
Entity Type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:MARLENE
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MARLENE
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15030 VENTURA BLVD # 124
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5470
Mailing Address - Country:US
Mailing Address - Phone:818-823-0352
Mailing Address - Fax:
Practice Address - Street 1:7555 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1949
Practice Address - Country:US
Practice Address - Phone:818-904-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA96826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health