Provider Demographics
NPI:1609976299
Name:TABB, JUDITH S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:S
Last Name:TABB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TAMAL PLZ
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 TAMAL PLZ
Practice Address - Street 2:SUITE 140
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1129
Practice Address - Country:US
Practice Address - Phone:415-924-4905
Practice Address - Fax:510-580-9460
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS69441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical