Provider Demographics
NPI:1518295385
Name:JUDICE, SAMUEL LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LAWRENCE
Last Name:JUDICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SPRUCE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1894
Mailing Address - Country:US
Mailing Address - Phone:415-859-5900
Mailing Address - Fax:
Practice Address - Street 1:341 SPRUCE ST
Practice Address - Street 2:SUITE E
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1894
Practice Address - Country:US
Practice Address - Phone:415-859-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG830282084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry