Provider Demographics
NPI:1497826226
Name:DESSOFFY, JUDITH HOLLER (MA)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:HOLLER
Last Name:DESSOFFY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12248 2ND STREET EAST
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4954
Mailing Address - Country:US
Mailing Address - Phone:727-460-6080
Mailing Address - Fax:727-399-8009
Practice Address - Street 1:13611 PARK BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-3437
Practice Address - Country:US
Practice Address - Phone:727-393-0384
Practice Address - Fax:727-399-8009
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4906101YM0800X
NC1190103T00000X
FLSS794103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool