Provider Demographics
NPI:1285851410
Name:NODDIN, JUDITH ALLISON (MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ALLISON
Last Name:NODDIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ELM ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-8401
Mailing Address - Country:US
Mailing Address - Phone:650-591-9623
Mailing Address - Fax:650-591-4163
Practice Address - Street 1:85 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2500
Practice Address - Country:US
Practice Address - Phone:650-755-0858
Practice Address - Fax:650-755-1754
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist