Provider Demographics
NPI:1588785182
Name:LUNDQUIST, JUDITH A (LCSW PLLC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:LCSW PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:572 TITUS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3519
Mailing Address - Country:US
Mailing Address - Phone:585-451-5126
Mailing Address - Fax:585-266-9336
Practice Address - Street 1:572 TITUS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3519
Practice Address - Country:US
Practice Address - Phone:585-451-5126
Practice Address - Fax:585-266-9336
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0212601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical