Provider Demographics
NPI:1811177173
Name:WALKER, JUDITH W (MED, MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:W
Last Name:WALKER
Suffix:
Gender:F
Credentials:MED, MSW, LCSW
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:W
Other - Last Name:FORMICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, MSW, LCSW
Mailing Address - Street 1:6237 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3906
Mailing Address - Country:US
Mailing Address - Phone:301-378-2737
Mailing Address - Fax:240-383-3439
Practice Address - Street 1:6237 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3906
Practice Address - Country:US
Practice Address - Phone:301-378-2737
Practice Address - Fax:240-383-3439
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038361041C0700X
MD08128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical