Provider Demographics
NPI:1295026284
Name:FLEISHMAN, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:FLEISHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3011
Mailing Address - Country:US
Mailing Address - Phone:978-807-5438
Mailing Address - Fax:
Practice Address - Street 1:425 HIGH ST
Practice Address - Street 2:SUITE7
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3674
Practice Address - Country:US
Practice Address - Phone:978-807-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical