Provider Demographics
NPI:1992036644
Name:ITURMENDI, JUDY M (PHD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:M
Last Name:ITURMENDI
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 1:315 WEST PONCE DE LEON AVENUE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2490
Mailing Address - Country:US
Mailing Address - Phone:404-373-2220
Mailing Address - Fax:404-373-9337
Practice Address - Street 1:315 WEST PONCE DE LEON AVENUE
Practice Address - Street 2:SUITE 350
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2490
Practice Address - Country:US
Practice Address - Phone:404-373-2220
Practice Address - Fax:404-373-9337
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003166103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist