Provider Demographics
NPI:1588739197
Name:EMERSON, JUDY A (LCSW)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:EMERSON
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 1:1753 E BROADWAY RD
Mailing Address - Street 2:SUITE 101-259
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2081
Mailing Address - Country:US
Mailing Address - Phone:480-829-9585
Mailing Address - Fax:480-962-5282
Practice Address - Street 1:1801 S JENTILLY LN
Practice Address - Street 2:SUITE #C2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5758
Practice Address - Country:US
Practice Address - Phone:480-829-9585
Practice Address - Fax:480-962-5282
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 2591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2506001OtherVALUE OPTIONS
AZ2506001OtherVALUE OPTIONS