Provider Demographics
NPI:1750336772
Name:ILLINGWORTH, JUDITH M (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:ILLINGWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 PARK AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1573
Mailing Address - Country:US
Mailing Address - Phone:215-529-9240
Mailing Address - Fax:215-529-9284
Practice Address - Street 1:1021 PARK AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1573
Practice Address - Country:US
Practice Address - Phone:215-529-9240
Practice Address - Fax:215-529-9284
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW009624L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1732364OtherHIGHMARK BLUE SHIELD
PA055768Medicare ID - Type Unspecified
PA1732364OtherHIGHMARK BLUE SHIELD