Provider Demographics
NPI:1821266818
Name:MAIDENBAUM, JUDITH COVITZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:COVITZ
Last Name:MAIDENBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAST 78TH STREET
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-628-0987
Mailing Address - Fax:
Practice Address - Street 1:11 EAST 78TH STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-628-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000589-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst