Provider Demographics
NPI:1477641140
Name:SOUWEINE, JUDITH (ED,D)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:SOUWEINE
Suffix:
Gender:F
Credentials:ED,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 BAY RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3504
Mailing Address - Country:US
Mailing Address - Phone:413-587-3265
Mailing Address - Fax:413-587-3268
Practice Address - Street 1:17 BREWSTER CT
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3801
Practice Address - Country:US
Practice Address - Phone:413-587-3265
Practice Address - Fax:413-587-3268
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3632103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1304186Medicaid