Provider Demographics
NPI:1518351154
Name:HEFREN, JUDITH E (PHD, MSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:HEFREN
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 SE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5464
Mailing Address - Country:US
Mailing Address - Phone:850-445-0260
Mailing Address - Fax:877-377-1386
Practice Address - Street 1:1906 SE 14TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5464
Practice Address - Country:US
Practice Address - Phone:850-445-0260
Practice Address - Fax:877-377-1386
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-21
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW155431041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102331100Medicaid