Provider Demographics
NPI:1407206154
Name:JUDY, CATARINA (LCSW)
Entity Type:Individual
Prefix:
First Name:CATARINA
Middle Name:
Last Name:JUDY
Suffix:
Gender:F
Credentials:LCSW
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 92312
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0103
Mailing Address - Country:US
Mailing Address - Phone:817-532-2645
Mailing Address - Fax:
Practice Address - Street 1:1207 S WHITE CHAPEL BLVD STE 260
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9344
Practice Address - Country:US
Practice Address - Phone:817-532-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0123051041C0700X
TX1110831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical