Provider Demographics
NPI:1376958413
Name:JUDKINS, MICHAEL BARRY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BARRY
Last Name:JUDKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 S JEFFERSON ST
Mailing Address - Street 2:APT 9
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3036
Mailing Address - Country:US
Mailing Address - Phone:347-733-3396
Mailing Address - Fax:
Practice Address - Street 1:1133 S JEFFERSON ST
Practice Address - Street 2:APT 9
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3036
Practice Address - Country:US
Practice Address - Phone:347-733-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000996103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst