Provider Demographics
NPI:1659429025
Name:KING, JUDY A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:A
Last Name:KING
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 1:195 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-280-3006
Mailing Address - Fax:
Practice Address - Street 1:195 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-280-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0265061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11240341OtherCAQH
373331OtherMHN
036387OtherVALUE OPTIONS
0006614OtherGHI
081344000OtherMAGELLAN
NY01965993Medicaid
EPDB434872COtherAETNA
P2531240OtherOXFORD
P2531240OtherOXFORD
EPDB434872COtherAETNA