Provider Demographics
NPI:1245356112
Name:HARRINGTON, JUDITH DEGRAZIA (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:DEGRAZIA
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:DEGRAZIA
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, HSPP
Mailing Address - Street 1:3000 MURVIHILL RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5960
Mailing Address - Country:US
Mailing Address - Phone:219-462-0246
Mailing Address - Fax:219-462-0226
Practice Address - Street 1:3000 MURVIHILL RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5960
Practice Address - Country:US
Practice Address - Phone:219-462-0246
Practice Address - Fax:219-462-0226
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0315103G00000X
AZ1919103G00000X
IN20042329A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002602075Medicaid
IN300017655Medicaid
NVV36100Medicare ID - Type UnspecifiedMEDICARE ID