Provider Demographics
NPI:1982743795
Name:WESTON-THOMPSON, JUDITH (MFT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:WESTON-THOMPSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:WESTON-THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:68 MARGARITA TER
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4732
Mailing Address - Country:US
Mailing Address - Phone:415-699-4058
Mailing Address - Fax:866-849-0672
Practice Address - Street 1:700 E ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2782
Practice Address - Country:US
Practice Address - Phone:415-457-3800
Practice Address - Fax:415-479-6545
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT23268106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist