Provider Demographics
NPI:1457576514
Name:HUNT, JUDITH GAIL
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:GAIL
Last Name:HUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:GAIL
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:11 MOUNTAIN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2343
Mailing Address - Country:US
Mailing Address - Phone:860-286-0528
Mailing Address - Fax:860-286-0585
Practice Address - Street 1:11 MOUNTAIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2343
Practice Address - Country:US
Practice Address - Phone:860-286-0528
Practice Address - Fax:860-286-0585
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1629145065OtherORGANIZATION