Provider Demographics
NPI:1356482632
Name:JUDD, KAREN L (PHD,CISW)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:JUDD
Suffix:
Gender:F
Credentials:PHD,CISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4213
Mailing Address - Country:US
Mailing Address - Phone:352-603-3919
Mailing Address - Fax:
Practice Address - Street 1:1601 MEADOW ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4213
Practice Address - Country:US
Practice Address - Phone:352-603-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765827300Medicaid