Provider Demographics
NPI:1457304719
Name:JUDGE, COLLEEN GORMAN (LMHC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:GORMAN
Last Name:JUDGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BARNES ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-2025
Mailing Address - Country:US
Mailing Address - Phone:401-949-9868
Mailing Address - Fax:
Practice Address - Street 1:33 COLLEGE HILL RD
Practice Address - Street 2:SUITE 30E
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2776
Practice Address - Country:US
Practice Address - Phone:401-821-6070
Practice Address - Fax:401-821-6047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
30240-5OtherBC/BS OF RI
2083869OtherCIGNA
409065OtherBLUECHIP