Provider Demographics
NPI:1659324713
Name:GUSTAFSON, JUDY KAY (LCSW, CAC)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:KAY
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:LCSW, CAC
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 5052
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-0952
Mailing Address - Country:US
Mailing Address - Phone:610-495-1530
Mailing Address - Fax:610-495-7840
Practice Address - Street 1:3310 W RIDGE PIKE
Practice Address - Street 2:SUITE 11
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3450
Practice Address - Country:US
Practice Address - Phone:610-495-1530
Practice Address - Fax:610-495-7840
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2707101YA0400X
PACW0153351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical