Provider Demographics
NPI:1396222550
Name:HALLE, JUDITH SHARON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:SHARON
Last Name:HALLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:SHARON
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:442 UPPER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1504
Mailing Address - Country:US
Mailing Address - Phone:201-739-4601
Mailing Address - Fax:
Practice Address - Street 1:71 FRANKLIN TPKE STE 1-2
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1800
Practice Address - Country:US
Practice Address - Phone:201-739-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011575103TC0700X
NJ35S100500800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical