Provider Demographics
NPI:1881754414
Name:GULKO, JUDITH (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:GULKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 W. SAMPLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4048
Mailing Address - Country:US
Mailing Address - Phone:954-825-0461
Mailing Address - Fax:954-825-0462
Practice Address - Street 1:9900 W. SAMPLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4048
Practice Address - Country:US
Practice Address - Phone:954-825-0461
Practice Address - Fax:954-825-0462
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5614103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical