Provider Demographics
NPI:1417090481
Name:JUDD, MATHEW L (LCSW)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:L
Last Name:JUDD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2990 INLAND EMPIRE BLVD
Practice Address - Street 2:#101
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4899
Practice Address - Country:US
Practice Address - Phone:909-980-3427
Practice Address - Fax:909-945-3426
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS188501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical