Provider Demographics
NPI:1770078610
Name:WIN, JUDITH DIETZ
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:DIETZ
Last Name:WIN
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 1:16 HURLBURT RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1552
Mailing Address - Country:US
Mailing Address - Phone:413-528-0366
Mailing Address - Fax:
Practice Address - Street 1:84 ALFORD RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1978
Practice Address - Country:US
Practice Address - Phone:413-528-7353
Practice Address - Fax:413-528-7358
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7786103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent