Provider Demographics
NPI:1952336976
Name:JUDGE, LISA CLARE (PHD LCSW)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CLARE
Last Name:JUDGE
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 503
Mailing Address - Street 2:1011 W 31ST ST
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-467-0655
Mailing Address - Fax:512-458-4569
Practice Address - Street 1:BOX 503
Practice Address - Street 2:1011 W 31ST ST
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-467-0655
Practice Address - Fax:512-458-4569
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27468OtherLICENSE LCSW
TX27468OtherLICENSE LCSW