Provider Demographics
NPI:1508206830
Name:HERMAN, JUDITH MUDGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MUDGE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PEABODY RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6639
Mailing Address - Country:US
Mailing Address - Phone:707-541-0182
Mailing Address - Fax:
Practice Address - Street 1:2100 PEABODY RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6639
Practice Address - Country:US
Practice Address - Phone:707-541-0182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13205103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist