Provider Demographics
NPI:1851080626
Name:MERBAUM, JUDITH P (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:P
Last Name:MERBAUM
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 1:8 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2726
Mailing Address - Country:US
Mailing Address - Phone:516-487-3430
Mailing Address - Fax:
Practice Address - Street 1:8 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2726
Practice Address - Country:US
Practice Address - Phone:516-487-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004259103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist