Provider Demographics
NPI:1316096845
Name:BOOKMAN, JUDITH S (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:S
Last Name:BOOKMAN
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 1:2670 UNION EXTD SUITE 610
Mailing Address - Street 2:CONCERN EAP
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112
Mailing Address - Country:US
Mailing Address - Phone:901-458-4000
Mailing Address - Fax:901-458-0048
Practice Address - Street 1:2670 UNION EXTD SUITE 610
Practice Address - Street 2:CONCERN EAP
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112
Practice Address - Country:US
Practice Address - Phone:901-458-4000
Practice Address - Fax:901-458-0048
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
3693517Medicare ID - Type Unspecified