Provider Demographics
NPI:1316076722
Name:PETRICK, JUDITH M (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:M
Last Name:PETRICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 LEIMERT BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2017
Mailing Address - Country:US
Mailing Address - Phone:510-530-2724
Mailing Address - Fax:
Practice Address - Street 1:5674 STONERIDGE DR STE 217
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8532
Practice Address - Country:US
Practice Address - Phone:925-462-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 18003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist