Provider Demographics
NPI:1790738938
Name:BARTHOLOMEW, JUDITH ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:BARTHOLOMEW
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 1:1329 BROADWAY ST
Mailing Address - Street 2:STE 202
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3747
Mailing Address - Country:US
Mailing Address - Phone:360-425-1322
Mailing Address - Fax:
Practice Address - Street 1:1329 BROADWAY ST
Practice Address - Street 2:STE 202
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3747
Practice Address - Country:US
Practice Address - Phone:360-425-1322
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000048041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA925914OtherREGENCE BLUE SHIELD OF WA