Provider Demographics
NPI:1316378029
Name:MANFREDI, JUDITH DIANE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:DIANE
Last Name:MANFREDI
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:PIDGEON, GARVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, QMHP
Mailing Address - Street 1:935 SHASTA AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2060 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-9538
Practice Address - Country:US
Practice Address - Phone:530-643-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist