Provider Demographics
NPI:1386700474
Name:DESJARDINS, JUDITH ANNE (LCSW,, BCD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:DESJARDINS
Suffix:
Gender:F
Credentials:LCSW,, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2717
Mailing Address - Country:US
Mailing Address - Phone:310-392-6281
Mailing Address - Fax:310-392-6281
Practice Address - Street 1:2001 PEARL ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2717
Practice Address - Country:US
Practice Address - Phone:310-392-6281
Practice Address - Fax:310-392-6281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS60181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical