Provider Demographics
NPI:1528397841
Name:PERRY, JUDITH (LISW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LISW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 YALE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3825
Mailing Address - Country:US
Mailing Address - Phone:505-272-1226
Mailing Address - Fax:
Practice Address - Street 1:1001 YALE NE
Practice Address - Street 2:UNMH CHILDRENS PSYCHIATRIC CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-272-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI062251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical