Provider Demographics
NPI:1770681892
Name:ADLER, JUDITH S (MFC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:S
Last Name:ADLER
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931
Mailing Address - Country:US
Mailing Address - Phone:707-992-0262
Mailing Address - Fax:707-795-6745
Practice Address - Street 1:101 MORRIS ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-992-0262
Practice Address - Fax:707-795-6745
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist