Provider Demographics
NPI:1992448229
Name:RADILOFF, JUDY JEANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:JEANNE
Last Name:RADILOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2919
Mailing Address - Country:US
Mailing Address - Phone:707-529-5318
Mailing Address - Fax:
Practice Address - Street 1:318 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2919
Practice Address - Country:US
Practice Address - Phone:707-529-5318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94026450103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist