Provider Demographics
NPI:1811041866
Name:PRICE, JUDITH LYNN SR (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNN
Last Name:PRICE
Suffix:SR
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 89TH ST
Mailing Address - Street 2:APT. 6H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1848
Mailing Address - Country:US
Mailing Address - Phone:212-873-3123
Mailing Address - Fax:212-595-1913
Practice Address - Street 1:201 W 89TH ST
Practice Address - Street 2:APT. 6H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1848
Practice Address - Country:US
Practice Address - Phone:212-873-3123
Practice Address - Fax:212-595-1913
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1574211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144702OtherVALUE OPTIONS
NY0063849OtherGHI-BMP
NY144702OtherVALUE OPTIONS