Provider Demographics
NPI:1134192396
Name:BEZDEK, JUDITH E (PH D)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:BEZDEK
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 S MCCOY PLACE RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8837
Mailing Address - Country:US
Mailing Address - Phone:412-741-4117
Mailing Address - Fax:412-741-4117
Practice Address - Street 1:166 S MCCOY PLACE RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8837
Practice Address - Country:US
Practice Address - Phone:412-741-4117
Practice Address - Fax:412-741-4117
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 008207-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01814532Medicaid
PA807839OtherBCBS
S17674Medicare UPIN
PABE807839Medicare ID - Type UnspecifiedPSYCHOLOGIST