Provider Demographics
NPI:1376681288
Name:MCINTYRE, JUDY (MS)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:JEAN
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:4448 SHANNONDALE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7701
Mailing Address - Country:US
Mailing Address - Phone:925-642-5239
Mailing Address - Fax:
Practice Address - Street 1:600 W 3RD ST STE E
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1293
Practice Address - Country:US
Practice Address - Phone:923-642-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist