Provider Demographics
NPI:1922099019
Name:DZIUGAS, JUDY G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:G
Last Name:DZIUGAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W PARK AVE
Mailing Address - Street 2:#130
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3357
Mailing Address - Country:US
Mailing Address - Phone:630-279-0845
Mailing Address - Fax:630-530-4441
Practice Address - Street 1:180 W PARK AVE
Practice Address - Street 2:#115
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3357
Practice Address - Country:US
Practice Address - Phone:630-279-0845
Practice Address - Fax:630-530-4441
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-29
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02222483OtherBLUE CROSS BLUE SHIELD
ILG23900OtherMAGELLAN
IL623900Medicare ID - Type Unspecified