Provider Demographics
NPI:1356490577
Name:GURTMAN, JUDITH H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:H
Last Name:GURTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:W CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07007
Mailing Address - Country:US
Mailing Address - Phone:973-227-1668
Mailing Address - Fax:
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:W CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006
Practice Address - Country:US
Practice Address - Phone:973-227-1668
Practice Address - Fax:646-415-9433
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ355100115000103TC0700X
NY016816103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
665127Medicare ID - Type Unspecified