Provider Demographics
NPI:1982113247
Name:HUOBER, JUDITH SIDMAN (LP-MHC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:SIDMAN
Last Name:HUOBER
Suffix:
Gender:F
Credentials:LP-MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2198
Mailing Address - Country:US
Mailing Address - Phone:315-446-9111
Mailing Address - Fax:315-446-1537
Practice Address - Street 1:4101 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2198
Practice Address - Country:US
Practice Address - Phone:315-446-9111
Practice Address - Fax:315-446-1537
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP108223101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY160975006Medicaid