Provider Demographics
NPI:1619074523
Name:WHEAT, JUDITH CLAIRE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:CLAIRE
Last Name:WHEAT
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 1:140 W 11TH ST
Mailing Address - Street 2:P.O. BOX 490
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3512
Mailing Address - Country:US
Mailing Address - Phone:540-660-1516
Mailing Address - Fax:540-660-2062
Practice Address - Street 1:140 W 11TH ST
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3512
Practice Address - Country:US
Practice Address - Phone:540-660-1516
Practice Address - Fax:540-660-2062
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1592101YP2500X
VA3460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA214735Medicare UPIN