Provider Demographics
NPI:1063566214
Name:TIMKE, JUDITH F (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:F
Last Name:TIMKE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7368 STATE ROUTE 42
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-7015
Mailing Address - Country:US
Mailing Address - Phone:845-985-7665
Mailing Address - Fax:
Practice Address - Street 1:7368 STATE ROUTE 42
Practice Address - Street 2:
Practice Address - City:GRAHAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12740-7015
Practice Address - Country:US
Practice Address - Phone:845-985-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032488-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTJ650003Medicare UPIN
NYNH0851Medicare ID - Type Unspecified
NY7480964Medicare UPIN
NY1031520Medicare UPIN