Provider Demographics
NPI:1710014006
Name:ANDRIOLA, JUDITH VIRGINIA (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:VIRGINIA
Last Name:ANDRIOLA
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:VIRGINIA
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5705 ROSE HILL CT
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583
Mailing Address - Country:US
Mailing Address - Phone:713-501-6904
Mailing Address - Fax:866-546-1671
Practice Address - Street 1:2225 COUNTY ROAD 90 STE 215
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5111
Practice Address - Country:US
Practice Address - Phone:281-489-1290
Practice Address - Fax:281-489-8806
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL294901041C0700X
TX29490101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170522002Medicaid