Provider Demographics
NPI:1780781724
Name:TIKTINSKY, JUDITH G (LCSW, MFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:G
Last Name:TIKTINSKY
Suffix:
Gender:F
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 COLUMBUS AVE
Mailing Address - Street 2:#413
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4599
Mailing Address - Country:US
Mailing Address - Phone:415-738-6249
Mailing Address - Fax:415-831-4750
Practice Address - Street 1:222 COLUMBUS AVE
Practice Address - Street 2:#413
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4599
Practice Address - Country:US
Practice Address - Phone:415-738-6249
Practice Address - Fax:415-831-4750
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 56621041C0700X
CA6689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist