Provider Demographics
NPI:1295860401
Name:GRADOS, JUDY JOHNSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:JOHNSON
Last Name:GRADOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 SIENA WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1241
Mailing Address - Country:US
Mailing Address - Phone:410-465-3181
Mailing Address - Fax:
Practice Address - Street 1:10709 BIRMINGHAM WAY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1403
Practice Address - Country:US
Practice Address - Phone:410-461-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3193103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist