Provider Demographics
NPI:1780725887
Name:GIBSON-JUDKINS, CASSANDRA ELAINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ELAINE
Last Name:GIBSON-JUDKINS
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 1:13001 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3752
Mailing Address - Country:US
Mailing Address - Phone:626-480-8107
Mailing Address - Fax:626-869-0280
Practice Address - Street 1:13001 RAMONA BLVD STE E
Practice Address - Street 2:
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-3752
Practice Address - Country:US
Practice Address - Phone:626-480-8107
Practice Address - Fax:626-869-0280
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS153541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical