Provider Demographics
NPI:1689717506
Name:SACHS, JUDITH ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:SACHS
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 1:14011 SHADY SHORES DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1932
Mailing Address - Country:US
Mailing Address - Phone:813-205-8153
Mailing Address - Fax:727-479-1248
Practice Address - Street 1:14041 ICOT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3702
Practice Address - Country:US
Practice Address - Phone:727-479-1800
Practice Address - Fax:727-479-1248
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 83961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768029500Medicaid
FLAG421ZOtherFIRST COAST - MEDICARE B