Provider Demographics
NPI:1063625390
Name:GRASER, JUDITH ANN
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:GRASER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:GRASER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ED D
Mailing Address - Street 1:2172 TARPON RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-1553
Mailing Address - Country:US
Mailing Address - Phone:239-285-4331
Mailing Address - Fax:239-435-0009
Practice Address - Street 1:720 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5656
Practice Address - Country:US
Practice Address - Phone:239-285-4331
Practice Address - Fax:239-435-0009
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY6271OtherPSYCHOLOGIST
FLPY6271OtherPSYCHOLOGIST
FLP56706Medicare UPIN