Provider Demographics
NPI:1518241819
Name:STODDARD, JUDITH N (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:N
Last Name:STODDARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HOLLOW OAK LANE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905
Mailing Address - Country:US
Mailing Address - Phone:203-918-5246
Mailing Address - Fax:203-274-5177
Practice Address - Street 1:18 HOLLOW OAK LANE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-918-5246
Practice Address - Fax:203-274-5177
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006555104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker