Provider Demographics
NPI:1962438655
Name:GOROVITZ, JUDITH B (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:B
Last Name:GOROVITZ
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:5069 PECK HILL RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9813
Mailing Address - Country:US
Mailing Address - Phone:315-445-2195
Mailing Address - Fax:315-445-2287
Practice Address - Street 1:1200 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1968
Practice Address - Country:US
Practice Address - Phone:315-471-1339
Practice Address - Fax:315-445-2287
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY8924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5407Medicare ID - Type Unspecified