Provider Demographics
NPI:1609964865
Name:SCHWARTZMAN, JUDITH B (PSYD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:B
Last Name:SCHWARTZMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 STRATHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1523
Mailing Address - Country:US
Mailing Address - Phone:937-667-2121
Mailing Address - Fax:937-667-9099
Practice Address - Street 1:15 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1808
Practice Address - Country:US
Practice Address - Phone:937-667-2121
Practice Address - Fax:937-667-9099
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5625103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2294459Medicaid
OH2294459Medicaid