Provider Demographics
NPI:1780467480
Name:WEST, JUDY LYNNITA (PEER SPECIALIST)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNNITA
Last Name:WEST
Suffix:
Gender:F
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:LYNNNITA
Other - Last Name:WEST-SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1235 SIMMS PL NE APT 11
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7829
Mailing Address - Country:US
Mailing Address - Phone:202-912-0210
Mailing Address - Fax:
Practice Address - Street 1:5656A 3RD ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2532
Practice Address - Country:US
Practice Address - Phone:202-916-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator