Provider Demographics
NPI:1235322298
Name:WALBRIDGE, JUDD PETER (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JUDD
Middle Name:PETER
Last Name:WALBRIDGE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5972
Mailing Address - Country:US
Mailing Address - Phone:802-264-5333
Mailing Address - Fax:802-264-5338
Practice Address - Street 1:245 S PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5972
Practice Address - Country:US
Practice Address - Phone:802-264-5333
Practice Address - Fax:802-264-5338
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT100-0000052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014041Medicaid