Provider Demographics
NPI:1972837136
Name:THACH, JUDY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:THACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E AVENIDA DE LA MERCED RM 108
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2752
Mailing Address - Country:US
Mailing Address - Phone:323-267-3400
Mailing Address - Fax:
Practice Address - Street 1:215 E AVENIDA DE LA MERCED RM 108
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2752
Practice Address - Country:US
Practice Address - Phone:323-887-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31753101YM0800X
CA700441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL