Provider Demographics
NPI:1609004043
Name:RAND, JUDITH ELLEN (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELLEN
Last Name:RAND
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:PO BOX 93575
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85070-3575
Mailing Address - Country:US
Mailing Address - Phone:480-399-6100
Mailing Address - Fax:210-593-9863
Practice Address - Street 1:1845 S DOBSON RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5662
Practice Address - Country:US
Practice Address - Phone:480-466-7010
Practice Address - Fax:480-219-5254
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4022103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical