Provider Demographics
NPI:1710017801
Name:LEVIN, JUDITH R (MFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:R
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MFT
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 343
Mailing Address - Street 2:
Mailing Address - City:WOODACRE
Mailing Address - State:CA
Mailing Address - Zip Code:94973-0343
Mailing Address - Country:US
Mailing Address - Phone:707-481-7435
Mailing Address - Fax:
Practice Address - Street 1:21 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:WOODACRE
Practice Address - State:CA
Practice Address - Zip Code:94973
Practice Address - Country:US
Practice Address - Phone:707-481-7435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39079101YM0800X
CA39079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health