Provider Demographics
NPI:1689613077
Name:LOBERG, JUDI
Entity Type:Individual
Prefix:
First Name:JUDI
Middle Name:
Last Name:LOBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2119
Mailing Address - Country:US
Mailing Address - Phone:919-929-3700
Mailing Address - Fax:919-929-3722
Practice Address - Street 1:307 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-2119
Practice Address - Country:US
Practice Address - Phone:919-929-3700
Practice Address - Fax:919-929-3722
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO21791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC52682OtherBLUE CROSS/BLUE SHIELD OF
NC2876472Medicare ID - Type UnspecifiedMEDICARE