Provider Demographics
NPI:1548417561
Name:PROCHASKA, JUDITH JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:JANE
Last Name:PROCHASKA
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 1:1265 WELCH RD # X306
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5102
Mailing Address - Country:US
Mailing Address - Phone:650-724-3608
Mailing Address - Fax:
Practice Address - Street 1:1265 WELCH RD # X306
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5102
Practice Address - Country:US
Practice Address - Phone:650-724-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA PSY 20687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical