Provider Demographics
NPI:1417429952
Name:YUDT, KIMBERLY JOANNE (ACSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOANNE
Last Name:YUDT
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 HAMPSHIRE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-497-0605
Mailing Address - Fax:
Practice Address - Street 1:660 HAMPSHIRE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-497-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81460103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst