Provider Demographics
NPI:1639221831
Name:DEUTSCH, JUDY JACOBS (MFT)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:JACOBS
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2213
Mailing Address - Country:US
Mailing Address - Phone:310-379-1663
Mailing Address - Fax:310-374-0244
Practice Address - Street 1:2100 N SEPULVEDA BLVD STE 33
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2958
Practice Address - Country:US
Practice Address - Phone:310-798-8260
Practice Address - Fax:310-374-0244
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health