Provider Demographics
NPI:1972723419
Name:KENT, JUDITH A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:KENT
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 1:4627 GORHAM DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-3112
Mailing Address - Country:US
Mailing Address - Phone:949-274-5502
Mailing Address - Fax:
Practice Address - Street 1:218 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7719
Practice Address - Country:US
Practice Address - Phone:714-505-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist