Provider Demographics
NPI:1881711067
Name:EDWARDS, JUDITH LEE (MFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SO ORANGE GROVE
Mailing Address - Street 2:#16
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-403-5942
Mailing Address - Fax:
Practice Address - Street 1:130 SO EUCLID
Practice Address - Street 2:#3
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-578-1566
Practice Address - Fax:626-578-1566
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT16072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist