Provider Demographics
NPI:1295925501
Name:JOUDY, RAEDA SALIM
Entity type:Individual
Prefix:MRS
First Name:RAEDA
Middle Name:SALIM
Last Name:JOUDY
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 1:1617 CORTE DE MEDEA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4804
Mailing Address - Country:US
Mailing Address - Phone:408-265-4087
Mailing Address - Fax:
Practice Address - Street 1:26081 MOCINE AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2923
Practice Address - Country:US
Practice Address - Phone:510-881-5921
Practice Address - Fax:510-881-5925
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA28972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program