Provider Demographics
NPI:1265569271
Name:NUSSBAUM, JUDITH ANN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 VENTURA BLVD
Mailing Address - Street 2:500
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2744
Mailing Address - Country:US
Mailing Address - Phone:818-222-8612
Mailing Address - Fax:
Practice Address - Street 1:16000 VENTURA BLVD
Practice Address - Street 2:500
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2744
Practice Address - Country:US
Practice Address - Phone:818-986-6340
Practice Address - Fax:818-986-4283
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMF18762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist