Provider Demographics
NPI:1194927624
Name:DEKLE, JUDITH WARD (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:WARD
Last Name:DEKLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 MCCAULEY WAY
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2970
Mailing Address - Country:US
Mailing Address - Phone:703-690-1426
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED ARMY MEDICAL CTR
Practice Address - Street 2:6900 GEORGIA AVENUE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-356-1012
Practice Address - Fax:202-782-4922
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 47561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical